First responders make the difference between life and death for trauma victims. But what is often not recognized is that when disaster strikes, spiritual caregivers are often among those first on the scene. For these caregivers response should also help propel survivors toward positive transformation. This book focuses on critical responses that are key in the aftermath of natural disaster, community violence, personal injury, and crime. These basics include: the power of presence, safety, assessment and triage, how we help, putting the pieces together, telling the story, hope, and caring in the long haul.
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About the Author
Jennifer S. Cisney, MA, CRT , is the Team Coordinator for the National Crisis Response Team of the American Association of Christian Counselors (AACC). She also is Director of AACC’s Christian Crisis Response Training Program. She led AACC’s response in New York City following 9/11 and functions as coordinator for all of AACC’s responses to local and national disasters. She is a member of AACC’s National Crisis Training Team.
Jennifer has served as a coordinator and presenter for the Grief, Crisis, and Disaster track at the AACC 2005 and 2007 World Conferences and the 2006 and 2008 East and West National Conferences and will serve as track leader for the Grief, Crisis and Disaster track at AACC’s 2009 “Grace and Truth” World Conference to be held in September 2009 at the Opryland Hotel in Nashville, TN. She is also a trained trainer with the International Critical Incident Stress Foundation in several courses including, Group Crisis Intervention, Grief Following Trauma, and Emotional and Spiritual Care in Disasters. Jennifer Cisney has served as faculty for many of AACC’s video-based training curriculum including “Life After Divorce,” “Christian Crisis Response Training,” and “Caring for Teens”. She will be an instructor in the “Care and Counseling for Traumatic Stress” training curriculum currently being jointly produced by “The American Association of Christian Counselors” and “Military Ministries,” a division of Campus Crusade for Christ. This program is scheduled to be released in October 2008.
Jennifer Cisney is a trained therapist and operated a counseling practice in the Charlotte, North Carolina area until August 2006.
Kevin Ellers, D.Min.
Territorial Disaster Services Coordinator
The Salvation Army Central Territory
10 W. Algonquin Rd
Des Plaines, IL 60016
Office: (847) 795-3293
Fax: (847) 294-2297
Read an Excerpt
The First 48 HoursSpiritual Caregivers as First Responders
By Jennifer S. Cisney
Abingdon PressCopyright © 2009 The United Methodist Publishing House
All right reserved.
Chapter OneCrisis Response 101
Readers who have had any training in crisis response, even a basic course, might find the information in this chapter very elementary. However, we realize there will be readers who have never had any formal training in crisis intervention or crisis response. For those individuals, it is critical to get some basic information that is generally covered in all introductory courses. So, for veterans, feel free to skip this chapter. But if you want to stay with us, a good review of the basics never hurt anyone.
Definition of a "Crisis"
It is evident that major crisis events in our country have escalated in recent decades, but so have the smaller incidents that affect individuals, families, and communities on a daily basis. In order to give you an appropriate introduction to the field, we need to offer some definitions and delineations that will help you understand the "language" of crisis response. We would like to define terms like critical incident, crisis, crisis intervention, and psychological first aid. You will hear all these terms during training and work as a crisis responder, and you should be aware of the distinctions and how each term is used.
A "critical incident" is the actual event that occurs. A critical incident can be any event that has potential to overwhelm the coping ability of individuals or groups exposed to the trauma. These can be large-scale events, such as terrorist attacks, hurricanes, floods, school shootings, and such. But a critical incident can also be any traumatic event— even those that directly affect only a small number of individuals. An automobile accident, a suicide, or a house fire are also critical incidents and can affect the individuals and families directly involved just as intensely as a hurricane or terrorist attack. The impact is what we define as a "crisis." A crisis is an acute psychological reaction to a critical incident or some distressing life circumstance. The critical incident (the event) is often confused with the crisis (a person's adverse reaction to the event). As a crisis responder, it is critical that you tailor your response to the reaction to the event rather than to the event itself. This is a very important distinction to make because if you respond to the event rather than the crisis, you may focus your attention on individuals who may not be having a crisis or who are only mildly affected while you bypass others who may be severely affected and in need of attention. If our work as crisis responders has taught us anything, it is that you cannot predict an individual's reaction to any traumatic event by evaluation of the event alone. An individual's reaction is a complicated combination of factors including the individual's personality, trauma history, support systems, life circumstances, and many other elements that come together to determine how any specific individual will be affected by a traumatic event.
An example of the importance of this distinction can be seen in the following story of a crisis response team. A group of college students were attending a school sporting event on a Saturday afternoon. Their team was losing badly at half time, so instead of staying for the remainder of the game, they decided to leave and go back to the off-campus apartment shared by two of the women in the group, Elizabeth and Abby. When the group of six students arrived at the apartment, they walked in on a young man who had broken into the apartment with the goal of robbery. Because he was unarmed when he was interrupted by the group, he picked up a large kitchen knife from the counter and grabbed Elizabeth, who was standing closest to him. Holding the knife to her throat, he threatened to kill her if he was not allowed to leave the apartment safely. As he backed slowly toward the door, he held the knife to Elizabeth's throat while continuing to threaten her friends that if they made one move toward him he would slit her throat. Once out the door he pushed Elizabeth down and fled the scene. A crisis response team was later dispatched to the school to do a group crisis intervention, called a defusing, with the group of students. As the crisis responders took the students through the steps of the intervention, Elizabeth seemed calm and relatively unaffected by the incident. In fact, many of her friends seemed more upset than she was. For one of the crisis responders, this was difficult to comprehend. She repeatedly questioned Elizabeth about how she was doing, focusing much of the group time and attention on Elizabeth. Elizabeth was a Christian and explained that from the moment the man grabbed her, she began to pray. She stated that God had given her peace in that first moment, and she just knew that the man would not hurt her. She continued to pray— but for the young man holding the knife. She sensed he was scared and in trouble, but that he would not hurt her. While many people might have been deeply affected by this incident, this young woman never felt that her life was truly threatened. The Holy Spirit gave her peace that prevented her from experiencing a level of fear that would be normal for such a situation. The crisis responder was convinced Elizabeth would have a delayed psychological crisis once she realized that her life had been in danger. While this type of delayed response can occur, that was not the case for Elizabeth. She was fine immediately following the event and would tell the same story months and years later. This critical incident never became a crisis for her.
However, her roommate, Abby, had a much different reaction to the event. While police and crisis responders focused on Elizabeth because she had had the most obviously traumatic experience, Abby was experiencing a psychological crisis significantly more intense than that of any of the other students. She was quiet and said little to responders during the group interventions. The crisis responders did not spend any one-on-one time with Abby, and she didn't ask for any time. While she seemed a bit anxious during the intervention, her symptoms would present in the days following the event. Over the following days and weeks, Abby was obviously agitated and displayed symptoms of traumatic stress including difficulty concentrating or focusing, inability to sleep, lack of appetite, and crying spells. All of these things can be normal responses to a traumatic event. However, a month later those symptoms had not subsided and had, in fact, gotten worse. It became clear that this incident had a tremendous impact on Abby. She was later referred to counseling. In the counseling, she revealed to her therapist that about nine months prior to the robbery incident, she had been the victim of rape at a party on campus. She had never received help or counseling and had not spoken to anyone about the rape. When she experienced the robbery, even though she was not the one facing the immediate physical threat, all the terror and fear she felt during her rape was triggered, and the posttraumatic stress was much more intense for her because it was combined with a delayed traumatic stress from the rape. Like many people who suffer most in the aftermath of a crisis, Abby had a prior trauma that she had not processed, and it made her reaction to the current stressful event much more severe. Because the crisis responders only looked at the event of Elizabeth having a knife held to her throat, they missed the crisis being experienced by Abby.
Now that you understand that we define a "crisis" not by an event but by the response of an individual or a group of people to an event, it is critical that you also have a very basic understanding of what occurs in the human brain and body during crisis. This very natural process leads to a state called "posttraumatic stress," also referred to as "critical incident stress." Posttraumatic stress is, again, a natural and adaptive part of human functioning. God provided us with this type of "alarm system," which helps us survive life-threatening situations. In our everyday language, we often refer to this reaction as the "fight or flight" response. When faced with danger or a situation that our brain interprets as dangerous, our bodies undergo a number of physiological and chemical changes. These changes are designed to help us "flee" the danger or "fight off" the danger, thus the term "fight or flight" response. Our brain releases chemicals in our bodies like adrenaline and cortisol. These hormones have many effects in our body, all of which are designed to be helpful in short-term dangerous or life-threatening situations. Physically, these effects prepare our bodies for fighting or fleeing by increased blood pressure and heart rate, providing maximum oxygen levels in the blood. Increased blood is sent to the extremities (arms and legs) so we can run faster and, in some cases, have increased strength. Significant changes in brain function occur as well. The function of the frontal cortex area of the brain is decreased after trauma. This area of the brain is responsible for much of our cognitive processing, rational thought, decision-making, and the integration of emotional and cognitive functioning. The function of the amygdala, the emotional center of the brain, is increased following trauma. The amygdala serves as the brain's memory bank and houses all our emotions, including fear and anger. Following trauma, the normal balance between our frontal cortex and the amygdala is disrupted (Ellers, Rikli, and Wright, 2006).
When the brain functions normally, the system functions well. However, traumatic events have the power to significantly change the brain's functioning. Trauma can cause a "wounding" to the bodily systems and may overwhelm the ordinary functioning modes. Trauma can create an altered state of functioning that can impair one's ability to perform essential tasks and frequently leads to psychological decomposition, or a "dumbing down" effect of cognitive impairment. The brain's design allows it to function as a holistic unit to create balance and appropriate levels of functioning. Traumatic events can overwhelm components and cause an interruption of functioning. Thus, trauma survivors may experience vivid graphic thoughts or images of the traumatic event with little or no emotion. The survivor may also experience intense emotions, but without the thoughts or actual memories and an impaired ability to cognitively process these emotions.
The intrusiveness of traumatic events can be so invasive that they may seem to temporarily take control of one's life. Survivors may find that they are washed back and forth between reliving the trauma, and being overwhelmed by floods of intense emotion, impulsive action, intrusive thoughts, involuntary physiological responses, and numbness and immobilization. The decrease in functioning of the frontal cortex creates a lessened ability to do basic left brain functions. Survivors may find a decreased ability to appropriately assess danger and distinguish between real and false threats. It may also limit people from putting into words what they feel. Thus, survivors may have an increased startle response and hypervigilance, falsely perceiving that there is danger (Ellers, Rikli, and Wright, 2006).
These symptoms, along with many others, are referred to as posttraumatic stress. Posttraumatic stress is a normal, healthy response to trauma and should not be pathologized. Instead, it is helpful to survivors if crisis responders normalize this set of symptoms, making it clear to the survivors that what they are experiencing is a "normal response to an abnormal event." This book will help you learn to identify the physical, emotional, psychological, behavioral, and spiritual symptoms that indicate that someone is experiencing posttraumatic stress.
It will be your responsibility as a crisis responder to identify common responses to a critical incident and to educate people on normal and abnormal responses. More about the responses to crises or "symptoms" will be discussed in the chapter on assessment and referral. The rest of this book is dedicated to helping those who are in the midst of experiencing this normal response to a very difficult and unusual experience or set of circumstances in their lives. The good news is that most of the people we respond to in times of crisis will recover fully from these very difficult times in their lives. Most will never need counseling and will not have long-lasting problems as a result of the traumatic events. Crisis intervention is about walking with people through this difficult time and facilitating their recovery through steps that will help them access their resilience and support their natural recovery processes.
But crisis intervention is also about recognizing individuals who may be having symptoms that go beyond normal posttraumatic stress or who seem at risk for further problems. The symptoms of posttraumatic stress are only normal and helpful within a limited time frame. For the majority of people who have experienced a traumatic event, posttraumatic stress symptoms will begin to subside within a few days. Within a few weeks, their brains and their bodies will be functioning normally again. However, for a small group of survivors, the symptoms not only persist, they can actually get worse. When the symptoms continue beyond one month or they are very severe, the individual needs to be assessed by a mental health professional. When normal posttraumatic stress does not resolve, it can become an anxiety disorder called Posttraumatic Stress Disorder or PTSD. All the steps we describe in this book are helpful for symptoms that are within the normal range. We want to make it clear that this book does not offer methods for treating individuals with PTSD. But this book will help you, as a crisis responder, know when a person in crisis needs to be referred to a mental health professional. Again, most people will need only the care, compassion, and competence of a trained crisis responder. The next chapter discusses one of the most basic helping concepts: how and when to be present in the lives of those in times of crisis.
Excerpted from The First 48 Hours by Jennifer S. Cisney Copyright © 2009 by The United Methodist Publishing House. Excerpted by permission of Abingdon Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
ContentsIntroduction: And Who Is My Neighbor?,
1: Crisis Response 101,
2: The Power of Presence,
3: Safety in Times of Crisis,
4: Assessment and Triage,
5: How We Help: Practical Assistance in Crisis Response,
6: Putting the Pieces Together,
7: Educating Survivors about the Past, Present, and Future,
8: Telling the Story,
9: Hope in Times of Crisis,
10: Caring for People over the Long Haul,
About the Authors,