16 - Delayed debriefing: after a disaster

Summary

EDITORIAL COMMENTS

This chapter challenges the conventions of psychological debriefing as an intervention that is only applicable in the earliest period post disaster. After dissecting debriefing as a trauma prevention strategy, Chemtob highlights the need to examine the traditional elements that have been seen to potentially prevent morbid outcomes. These include prevention aims, supporting processing of the emotions, dealing with the cognitive distortion produced by the event, providing systematic information about the course of recovery over time so as to counter perceptions generated by cognitive disturbances, social support, public health screening and monitoring function. Three additional ‘propositions’ are added to this list as a result of the author's clinical observations and research: adaptation to the cultural environment, debriefing specific to the psychological tasks of the particular phase of recovery, taking into account individually specific ways of responding to life events. The last of these the author has described further in terms of ‘survival-mode’ psychological distortions that people use for necessary adaptation. He considers that understanding of these through education is likely to assist the recovery process.

Chemtob makes a strong case for the ‘clear specification of procedural steps’ involved in debriefing before it can be appropriately evaluated for intervention integrity and Wdelity and for effectiveness as a preventive approach to post-trauma morbidity. debriefing research is limited and findings difficult to appraise because procedures and aims have seldom been defined or measured.