Listening for Themes and Teaching to Issues: The Importance for CISM Responders

I believe that the primary purpose of all CISM interventions is education.

While CISM interventions are an effective series of crisis intervention techniques, at its heart is the provision of information; information which other people just like them, who have experienced a similar event, have found helpful in their return to pre-incident functioning. We want to assist them in their natural resiliency and ability to “bounce back”.

We all end our standard interventions by teaching about some stress management techniques. While useful, it is not enough. If we do not teach about the important issues that arise while the personnel are “telling their story”, we have missed the most important part of this critical phase. It is important to discuss these critical issues that have emerged during the response.

So what are some of the most common themes?

After providing CISM services for over thirty years, experience has shown me that there are a few core topics that often arise. Of course, there are some variations based on the incident and the participants. Some of the most common themes are:

Personal Themes

We have long recognized that Guilt and Anger are universal reactions to difficult events, but I am convinced that Grief/Loss is also universal. I believe that Grief is not just grief for the person that died, but personnel are also dealing with intangible losses. The loss of sense of personal safety is at the core. This might include real personal safety (“it could happen to me”) or understanding that it could happen to their family members/children, too. We grieve the loss of sense of immortality (for self and family members), the loss of sense of justice (“it is not fair that this happened”), the loss of sense of control, the loss of sense of spirituality, and the loss of sense of self identity (“if we did not behave in the way we thought we should have”).

Understanding that the grieving process is not done in sequential phases or steps, but rather it seems to come and go in waves, which typically gradually diminish. However, sometimes they come roaring back unexpectedly, which is important to understand and accept. I have found explaining these intangible losses, and the grieving that goes with it, to be both important and helpful to participants.

In addition to personal themes that frequently emerge, other issues can also be difficult for participants to handle and you might need to address them. These include:

• • Explaining some basic facts about suicide deaths
  • What to say to the victim’s family at the visitation or funeral
  • What to say to their own family when they come home
  • Spiritual challenges
  • How to handle flashbacks/intrusive thoughts                   
  • What to say to children
  • How to handle triggers to the previous event

If we are not prepared to teach about these important issues, we have not fully assisted personnel in their return to adaptive functioning. Let’s give them the full measure of our knowledge and education on all these issues.