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Critical Incident Stress Debriefing

EFt Tapping Outdated ImageNote: This is one of 3,000 articles written prior to the updated Gold Standard (Official) EFT Tapping Tutorial™. As a result, it is likely outdated. It provides practical uses for EFT Tapping but you should also explore our newest advancement, Optimal EFT, by reading our free e-book, The Unseen Therapist™, and/or get help from a Certified EFT Practitioner.

by Deborah Mitnick

(Several messages included on this page. It reads like a story. You may want to print it out.)

Hello, EFT.

Tomorrow I'll be conducting a Critical Incident Stress Debriefing (CISD) session for an organization that experienced the sudden death of a patient this morning. I'll be working with over 30 staff members and then may also hold a separate debriefing for the many patients who work with this staff and who were friends or acquaintances of the deceased.

I plan to introduce some rounds of EFT during the standard debriefing. I wondered if any of you have done this? The group wants the traditional CISD session (at least that's what they *think* they want), but my gut tells me that EFT would probably lead to more healing than CISD alone. It's important to them to tell about the event: when they heard about it; what their reactions were when they heard; what their first thoughts were; how they're coping... This is standard debriefing.

But I think tapping will probably help more than all of the sharing that comes with the routine debrief. Has anyone tried this in such a group or so soon after a traumatic loss?

I'd love to hear about your experiences. I'm also wondering if tapping would be more effective if it's done at intervals, after a number of people have spoken, or if it would be better for me to continually model the tapping while people are talking about their experiences.

Thanks for any and all feedback.

Deborah Mitnick, LCSW-C


Willem Lammers Comments

Deborah,

I'm very interested in the reactions you will get. I'm somewhat reluctant to go for an EFT resolution immediately. If people want a standard debriefing and are familiar with it, you should pace with them in fulfilling this wish at least partly. In the occasions I used EFT immediately after a traumatic event I got sometimes a reaction that people didn't feel taken seriously in the intensity and quality of their emotions. In other words: the therapeutic relationship was not solid enough to go for the solution so fast.

My hunch is that when you make contact with them first by using a familiar method, you can easily take the lead and introduce EFT. Otherwise it will work as a cheap trick, which people are not willing to learn because they are not receptive in their stress following the death of the patient, with all the guilt and anger connected to it. I'm planning a new trauma course in England in October, in which I want to teach facts about trauma, the basic attitude of CISD -which is in fact designed to support healthy processing of traumatic events- and the principles of trauma work with tapping. As I understand CISD, the most important aspects of it are that the debriefer is present for the client, and that s/he teaches the client what can happen in a traumatic situation. The detailed CISD exchange about what happened exactly during and after the traumatizing situation seems to me not that necessary anymore. The first two principles, however, are just as important as before. These two principles can thus be used as a start, in combination with the teaching and the theory behind the method.

I wish you a good meeting,
Ciao,


Willem Lammers


Lee Bowers comments

In response to Deborah Mitnick's question about using EFT during a Critical Incident Stress Debriefing: She states:

"I plan to introduce some rounds of EFT during the standard debriefing. I wondered if any of you have done this? The group wants the traditional CISD session (at least that's what they *think* they want), but my gut tells me that EFT would probably lead to more healing than CISD alone.

I am very experienced in CISD - Going all the way back to when I was an Air Force Officer during Vietnam. More recently, I am frequently called in after bank robberies - especially if a teller has had a gun to her head. My experience is that when the trauma is acute and very fresh, people are still in various stages of shock and need to talk a lot to just process and work through the shock reaction. Doing something as "bizarre" as EFT is so incongruent to them that they may feel they have not been heard. Pacing is important.

I find that EFT is most effective a week or so later, after people have had a chance to sort things out cognitively, and are dealing with issues of grief, guilt, memories, etc. On the other hand, if the trauma is chronic (on going abuse, for example), I think EFT is great whenever it's used.

Hope this helps.

Lee A. Bowers, Ph.D.


Larry Stoler comments

Deborah--thanks for posing this interesting clinical issue to the EFT group. I've been involved in 4 CISD situations. I wish had been comfortable using EFT in all of them, but used it only once. On that occasion, I was intervening with a small work group in a small manufacturing plant. These workers, all on the night shift, were there when one of the group had his hands amputated in a punch press. I could not get there right away. I ended up meeting with them at their worksite almost 1 week later, so this is clearly not a typical CISD situation. I met with a group of about 8 employees. They were all very stoic. Many of them commented about many worse things they had seen in the Korean war, or in their personal lives. They were all pretty sealed up about the incident. One employee, a mechanic, was still having trouble with the incident, suffering anxiety, concentration problems, nightmares, and was afraid to be working near that machine.

After the group left, I offered to meet with him alone and he was willing. He was a very nice guy, but definitely not psychologically minded or the therapy seeking type. I told him confidently that I had an approach that I was quite sure would help to diminish his anxiety and distress. He was open to this and I proceeded to treat him. After about 35 minutes, he was completely free of distress. He was amazed and confused, but pleased with what had occurred. I promised to follow up with him in a few days and encouraged him to contact me if he had any return of the problems. When I called him back, he was doing fine. No more anxiety, no more intrusive thoughts or images, and he was now doing the maintenance on that machine.

Given this experience, here is how I would approach a CISD intervention today. In my introduction, I would cover the general CISD ground rules and expectations, and I would add that I am willing to teach people specific "relaxation" methods that help people manage or get through difficult emotional times. I would provide all the time the group needs to talk about this event, and at the same time I would evaluate how the process of healing is moving. That is, are the group dynamics intact enough to help the individuals there deal with this loss? If things seem to be moving along well enough, I might let it be. If there is an individual in the group that I suspected might be having a harder time than others, I might offer something specific to that person (as above). I could see myself teaching them EFT as part of summing up the intervention as a specific self-help tool that everyone could learn. That would be a time to demonstrate with the group. Or, if I felt that the distress in the group was sufficiently intense and not moving, I would introduce EFT and treat the group at that moment.

What I am discovering about integrating EFT is:

To use EFT as early as possible, because it can so rapidly alleviate distress and suffering.
To honor my clinical judgment, and my connection with the client regarding whether it is sound to do EFT early on in any treatment.
Healing can happen in so many ways. I can use all the tools I have or none of them as long as I maintain good rapport with the client, and let the healing happen through us.

Peace,

Larry Stoler, PhD


Deborah Mitnick provides an update and more responses

Hello, EFT.

I'm about to head out to do the debriefing. I've tapped for my anxiety about "doing it right" and I feel fabulous! I hope I'll be able to report a success to you later tonight. But I'll report *whatever* happens, I promise.

I wanted to let you read some of the back-channel posts I've received. There are a few folks who don't want me to send their posts on, but here are some on the subject.

Thank you for all of your support!

Deborah Mitnick LCSW-C


Hi Deborah,

I work in a traumatic death grief program, and am a member of the NM CISM team. My colleague and I are frequently called upon to do just what you are doing. We do a debriefing in the 5 step format, but listen for and encourage expressions of grief. We do grief care of self ed, rather than EMS stress ed, and before ending, ask if any has anything they want to add.

Usually someone will want to eulogize for a few minutes.

Good luck with it.

Carol Chapin


Deborah,

I have done debriefings for 10 years of all varieties and I wouldn't mess with the standard debriefing model. I would use the EFT in the education and pulling together segment towards the end when some of the discharge has happened and there is more rapport with the group. I have had one experience where there were some who took to it but others resisted and resented it - I can't judge there needs to do what they must- then the ones who benefited didn't get as much from it because they were in a space that they were not comfortable challenging their peers. I tend to lean in the direction that you do in terms of helping these folks get further - faster but I also must respect where they are. Someone has pointed out to me the benefits and the downside of resolving these experiences quickly. It is probably worth longer discussions later.

Peace,

Rick Ritter LCSW

Certified Traumatologist


Hi Deborah,

I haven't tried tapping in any of the CISDs I've done (as much as I feel certain that it would be very helpful for many folks!) because many of the debriefings that I've done involved Emergency Services folks. Very well-defended usually; NOT big on anything that may smack of hocus-pocus or voodoo to those who do not yet understand what this stuff is all about. My suggestion would be to inform the group that if anyone is interested after the conclusion of the debriefing in a technique that can be taught to further lessen the distress... I remember in my CISD training that the instructor sometimes did EMDR for the folks remaining stuck AFTER the debriefing. She did it for each person individually. Although EMDR is not taught and tapping is, the idea may be the same, in that people would have privacy and choice and not have to be put in the position of doing something just because the rest of the group is doing it. Just a thought....Good luck in tomorrow's briefing;

I'd like to hear how you decide what to do and how it works.

Regards,

Kathy Heuser, Psy.D.(c)


Deborah Mitnick reports on her CISD session

Hello, EFT.

Here is my report on my CISD session today.

The formal session was 90 minutes and I ran it as a formal session, but would definitely have thrown in EFT if the need was strong. Here's how I assessed the need/lack of need for it:

There were 20 people in the room. I introduced myself and set the ground rules for the session. I described the structure of the seven-step CISD process and told them that if, at any time, they developed any emotional intensity, I could provide a very quick relaxation exercise that would probably diminish the intensity. I asked for SUDS ratings. There were three people at an 8-9, most at 5-6, and a few at 3-4. There was one person quietly weeping. The director had described her to me before the session and she was certainly easy to pick out. The Director said she'd been crying for 24 hours. She never established eye contact with me and I didn't think it was appropriate to call any attention to her at this time.

The group quickly opened up to respond to my "Fact-Phase" questions. SUDS after this phase was reduced for all (who admitted their levels) but two people. Weeping Woman (WW) was now quietly hiccuping, but no longer crying. During the "Thought-Phase" there was a lot of laughter and gallows humor (to be expected in such a session). The group felt comfortable with each other and with me. WW now was watching me carefully when I asked SUDS level. Most folks continued to report lowered levels. They were anxious to move on to "Reaction-Phase." One person (Stoic Lady: SL) admitted an intensity of 8, but insisted that she was "ok." I asked if it would be ok with her to be less intense and she said, "I'm used to feeling like this. I'm ok." I did a little teaching here with light humor and she said that she'd "probably" want to stay to "try your relaxation thing" after the formal session.

During the Reaction-Phase, SL expressed a lot of anger and sense of responsibility and guilt for not "seeing" and "preventing" the problem that led to the death. Many people expressed guilt and anger and the group began to talk more objectively about the deceased. The deceased was no longer being idealized. Instead, the group noticed that she had "been hiding" the problem that led to the death. They began to put the responsibility for her life back on her and there was a "group sigh" that was actually audible. SUDS level was even lower now. WW was nodding her head to the responses of others. SL said her level dropped to a 5.

In the "Symptom-Phase," they discussed numbness, lack of concentration, and many expressed worry that they thought they were hearing her voice, smelling her mints and imagining she was there. They discussed their headaches, nausea, backaches, etc. They asked questions about if they were "processing" correctly and one person wondered if he was "doing it right" because he hadn't yet cried. SL said she could barely grieve about this loss because she'd had so *many* losses this year and couldn't concentrate on this one. Her SUDS was now a 6. The group lovingly told her they'd like her to work with me and others volunteered to join her in that after the formal session.

In the "Teaching Phase," I told them that I'd give a session of emotional relaxation after the formal session, but if they couldn't stay for that, I described a breathing exercise that they could do at home. I also suggested another relaxation exercise of noticing the tension, for example, in their hands, then exaggerating it to make themselves *more* tense, and then releasing it. They tried that and liked it. I anticipated with them that they may experience guilt or "missing her" or loneliness or sense of aloneness and some admitted that they already had that. (I offered to work with those issues after the formal session, but no one approached me about that afterwards.) SUDS was very low here for most people. Participants were now slouching in their chairs with their hands behind their heads or had their arms slung over the backs of their chairs. No one was sitting forward and clenching hands or jaws now.

During the "Re-entry Phase" people began to plan tributes to the deceased and a few eulogized her. They talked about planning to attend the funeral. They complimented each other on their professionalism with the clients and with each other during a very stressful time. They thanked the director of the program for providing them with the CISD opportunity. When I asked them what they found most/least valuable from our meeting, everyone who spoke said that the session helped clarify issues, helped express emotions, gave a safe space, and allowed healing to take place. SUDS was lower than at the beginning for everyone (who admitted it) in the room. SL said she was a 5, "but I'm ok with that." WW was looking intently at me. I thanked them for their participation and told them about my experience of being with them. I told them that I was honored that they let me share this time with them; that I admired how they worked together and how committed they appeared to be to their jobs and their clients. I said (and sincerely mean it) that I felt emotionally enhanced by being with them.

During the "Refreshment-Phase," many people came up to tell me their life-stories. The Director asked me to show her the relaxation technique and wanted to work on her fatigue, which she associated with sadness. Her SUDS 3 went to 0. SL told me that she couldn't grieve this current death because her best friend was murdered recently and that's all she could think about. SUDS: 9. She and three friends went through two rounds of tapping and then she was at a 3. She wanted to stop there, but she spent 10 minutes asking me questions about how the method worked.

WW disappeared the minute the formal meeting was over. The Director went to retrieve her. I later found WW standing in the middle of the room, looking at nothing. I went over to her; she sort-of smiled. I asked what her job was at this place and how long she worked there. She attempted to smile as she answered my small talk. I then asked, "How's it going now?" and she burst into tears. I offered to work with her and she accepted.

We went to a private room and for 40 minutes, we worked together with EFT. For each initial round, she was too upset to say the PR affirmation or tap on herself. She gave me permission to do it all for her. I consistently did the tapping for her, but she was always able to say the second and subsequent rounds of PR affirmations for each aspect. PR was not always present. I used short-cut sequence, the whole thing, and head, ankles, and wrists, when I thought one of those sequences was indicated. Sometimes I only tapped one or two points and the results were just fine. Thanks to what I learned from the advanced tapes, I was also able to trust my intuition to assess accurately what her SUDS was each time. She only needed 2-3 rounds for most of the aspects.

Here's my assessment of our 40-minute session: When I was doing traditional psychotherapy, this amount of material would probably have taken about 18 months to address. (Notice that I didn't say "resolve.") In this session, she handled in this order: "all this emotion, this death emotion, this [deceased's name] feeling, hearing about her death, guilt, responsibility, missing her, anger, losing a good friend, thinking I could have changed the outcome, why did she do that, feeling lost and lonely, and what a way to die."

I tested each statement at the end by having her repeat statements, such as "I'm responsible for her death." No increase of SUDS for any statements like that. Smiles. Sighs. Relief expressed.

I educated her about the possibility of other aspects emerging and she asked to see me tomorrow for a follow-up session. The Director agreed and contracted with me to come back to work with WW tomorrow and with others if they need it.

CISD and EFT: I think that EFT is a fine adjunct to a CISD session. If there is a next-time need for CISD anywhere, I'll be more bold about introducing EFT during the formal session. I think that the talking they did today was *necessary* and they would have felt cheated if the session had been any shorter. (This is my shortest CISD session ever!) Yet I don't think that all of the emotional pain I witnessed was absolutely necessary to have while they were going through the CISD stages. (I remember in my traditional-therapy days believing that pain was necessary in order for therapy to really work. I encouraged people to feel pain, I think).

I think asking for SUDS ratings is a wonderful tool. I was much better able to stay in touch with the emotion in the room this way. My asking also seemed to endear me to the group. They seemed to think it was "cute" that I took care of them this way. This specific group "believed" that they had to suffer a little bit in a CISD session because that's what they were taught and what they expected. Gary's right. It would have been inappropriate for me to violate those beliefs by introducing EFT before the group could have enough of its suffering.

I always try to build rapport with a group and I'm usually successful, but Gary's statement about "rapport-building" in his recent post to me led me to a greater awareness of how I can best build rapport. I think I was successful today.

If I have another CISD, if the group is receptive, I'd want to start with a round or two of EFT. Why not? I believe that my growing EFT reputation will allow this to happen.

And now, thank you.

Gary, thank you for providing me with this wonderful EFT tool. Thank you for all of the phone and e-mail communication that has assisted me in getting through my barriers so that I can do this work so effectively.

EFT Forum Members, thank you for your wonderful and thoughtful responses, suggestions, observations, and support, caring and love. I get it! I've learned so much from *all* of the posts that have appeared on this list over the many months. Thank you for your quick response to me on this issue. With your help, I had the confidence to handle this situation on a level that I assess to be much higher than any other CISD success I've had.

You helped me find my courage. I thank whatever Higher Power was helping me today. And I'm pretty pleased with myself for opening my mind to accept these new skills.

I find this work to be profound. I have felt very good about most of the things I've done in my life. But EFT is the most rewarding work I've ever done.

I feel blessed to know all of you.

Love.

Deborah Mitnick, LCSW-C


From Weeping Woman to Laughing Lady

Hello, EFT.

Here's an update from my Thursday CISD and private session with Weeping Woman (WW).

I wrote to Gary on Friday morning to ask his advice about how to handle my follow-up session on Friday with WW. I'm posting my question to him and his answer, which he suggested I post to the list. Then I'll have a few more comments.

********

Hi, Gary.

I just called WW at work (It's 9:00 AM). She slept great last night and felt fine all evening. When she got to work she was a 4 with stomach ache and tension. After 4 phone minutes with EFT using shortcut and PR, she's now a 0. She wants to work in person this afternoon.

She isn't very articulate and can't focus too easily on what issues may still be there. My guess it that she has very low self-esteem, just by looking at her. I'll meet with her today. Should I be *guessing* what the problems might be, related to the death of the co-worker, or do I need to follow only what she is able to say to me about it?

If today is the only day that we're authorized to work together, what would you recommend?

Deborah.


Deborah,

I would listen to what she says AND do some "guessing" (intuiting). She may not be able to articulate (or even be aware) of her core issues. Chances are we have a replay here of my session with "Claudette" at the Laurel, Maryland Power Therapies Conference. She may be projecting onto the recent trauma some fears, guilt, etc. from past events. It may be more efficient to tap on those past events.

Most important here is to convince her to tap daily (10 times per day for several months) on general issues such as "all these problems," "my general sadness," "low self esteem," "my life doesn't work" etc. The results are almost always gradual, subtle and very REAL. Issues get handled "behind the scenes" and major shifts occur in the resulting self image. The client doesn't usually notice the results right away, however, even though they are happening. This is because of the subtle nature of the changes. The client usually adopts the changes as though there was never a problem in the first place. This is healthy, of course, but the client often needs to be reminded of her "before and after" to recognize the results.

Love, Gary


This is my report of Friday's session:

I met with WW at her place of work for one hour in the afternoon. She was smiling and looking relaxed. Here's what she said: "Talking to you yesterday made me feel better. I can deal with this more now. I haven't cried any more and now I can work. I can talk about it better. I don't get upset about it. I slept better. Her dying is not my fault. Yesterday I thought I could do something for her, but I now know that I did everything I could have done. I was there for her and I know she appreciated that. I do feel bad that it had to come to this [her dying], and I wish she could have talked to me, but I feel fine about it now."

I wanted to "test" her the way I've seen and heard Gary do, so I had her repeat many statements that we had needed to tap for on Thursday. For example: "I'm responsible for her death." "I should have done more." "I missed the signs." "I could have changed the outcome." "I lost a good friend." "I'm going to miss her." "She's dead."

For each of these statements, she reported a SUDS of 0. She smiled. She laughed and expressed wonder and amazement that she felt so good and uncharged while making these statements. She said, "I'll miss her and it's sad that she died, but I don't feel upset inside now."

Fifteen minutes of our session had passed. I wondered if I should leave. But I decided to ask her to anticipate how it would be to go to the funeral on Sunday. She agreed to this exercise. Using Gary's technique that I learned on the advanced tapes, I asked her to think about what SUDS rating she would have if I asked her to close her eyes and imagine the funeral scene. That number was 0. I then had her close her eyes and run through the "movie" of the funeral, from the time she started to get dressed for it, driving there, walking up to the casket, looking at the body, seeing the family, hearing the sounds of crying, etc., etc. She still reported a SUDS of 0.

She then wanted to review previous losses she's suffered and we discussed the deaths of a few of her extremely close relatives, the guilt she felt about what she had or hadn't done in relation to these relatives, the funeral and casket scenes, and her own fears of death that came from those experiences. She did not feel intense about any of these topics. She said, "If you had asked me about these yesterday or any time before that, I would be sobbing now." I said, "Why do you think you're not sobbing?" She said, "This tapping seems to have straightened me out about a lot of things, I guess."

We discussed that if she were to cry at the funeral, that would not be at all abnormal; and it would not be abnormal to feel sad and weepy. I said that the tapping is not meant to take away "normal" responses to events. She said she understood that and said she'd be "ok" at the funeral. Just to be sure, she said she wanted to tap for the following things, and so we did: "All these losses." "[Deceased's] death reminds me of my other losses." "Seeing the casket anxiety."

The hour was up and she was happy and relaxed. She asked me how she could use the tapping on some physical problems and on self-esteem issues she's had and I gave her a little information about that. I invited her to call me for brief phone sessions, if she wanted. She laughed and thanked me and said that her co-workers and husband were amazed at the changes they'd noticed.

So, I said goodbye to Laughing Lady (LL)!

Later that day, the Director of the program called me to tell me how pleased she was in the transformation she noticed of WW to LL! She also said that everyone who had attended the debriefing was doing well and that many had achieved the desired closure from that meeting. She said, "I got double mileage from having you here. My staff is doing so much better and people have noticed how much this company cares about them to have provided your services."

This is the end of my report. Thanks again for all of your original help and your wonderful, supportive comments to my last report.

Deborah Mitnick, LCSW-C

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