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Book Forum: Posttraumatic Stress   |    
Psychological Debriefing: Theory, Practice and Evidence
Am J Psychiatry 2002;159:686-687. doi:10.1176/appi.ajp.159.4.686
View Author and Article Information
Detroit, Mich.

Edited by Beverly Raphael and John P. Wilson. Cambridge, U.K., Cambridge University Press, 2000, 376 pp., $59.95 (paper).

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Psychological debriefing has become a fairly popular intervention used for victims and witnesses of traumatic events. Some employers feel obliged to provide debriefing after trauma encountered at work. Numerous “debriefing counselors” have been descending on disaster sites offering their “debriefing skills.” Debriefing has slowly become a new industry. Interestingly, it is not clear whether debriefing has any role in the treatment and prevention of psychological trauma. It is also not clear who should be performing debriefing, when, and with whom. Trauma psychology researchers have not reached an agreement about the conceptualization and definition of debriefing. Thus, one might ask what debriefing is. According to the editors of this book, it means telling about what has happened, or going over an experience or set of actions, to achieve some sort of order or meaning concerning them. In their chapter, Dr. Ursano and colleagues define debriefing as a “systematic process of education, emotional expression, cognitive reorganization through the provision of information, fostering meaningful integration and group support through identifying shared common experience.”

Debriefing has been ripe for reevaluation, and this book provides quite a thorough and timely reevaluation of this field. The editors gathered a group of 41 authors who have “made a significant contribution to the evolution of the field of debriefing.” The book consists of an introduction by the editors, 25 chapters organized into four sections, and a conclusion. The introduction summarizes the key issues in the conceptualization of debriefing and points out its historical foundation. The editors emphasize that the scientific underpinning of debriefing needs to evolve to validate its relevance to acute posttrauma response and to ultimate recovery.

Part 1, Key Conceptual Framework of Debriefing, consists of four chapters. The first three are well written and informative. The overall message of the first chapter is that debriefing should sit in the spectrum of response to those who have suffered severe psychological trauma, and that the reason for early intervention is a moral one. However, it also points out that the conceptual basis for debriefing is very elusive. The second chapter brings our attention to the fact that there appears to be little evidence that talk reduces the symptoms that may follow trauma, although it may affect other outcomes, such as distress and disability. It also discusses who attends debriefing and who talks during debriefing. The third chapter describes five categories of groups in group stress debriefing and provides historical glimpses on support provided after psychological trauma. I enjoyed the comment in the discussion of the role of the church in posttrauma support: “Compared with what the priest can do for the soul, the medical doctor is a rather helpless person.” The chapter closes with a discussion of leadership responsibility and the role of mental health professionals in stress management.

The second section, Debriefing: Models, Research and Practice, contains 11 uneven chapters dealing with specific issues: “Critical Incident Stress Debriefing: Evolutions, Effects and Outcomes,” “Debriefing With Emergency Services: Critical Incident Stress Management,” “Debriefing and Body Recovery: War Grave Soldiers,” “Debriefing and Body Recovery: Police in a Civilian Disaster,” “Debriefing After Massive Road Trauma: Perceptions and Outcomes,” “Debriefing and Motor Vehicle Accidents: Interventions and Outcomes,” “Debriefing With Service Personnel in War and Peace Roles: Experience and Outcomes,” “Debriefing Post Disaster: Follow-Up After a Major Earthquake,” “Debriefing After Disaster,” “Children and Debriefing: Theory, Interventions and Outcomes,” “Debriefing Adolescents After Critical Life Events.”

The chapters on children and adolescents involve a controversial area. The chapters on body handling and debriefing with service personnel clearly stand out as the most interesting. They emphasize that professionals lack training in debriefing and in handling traumatic situations. The author of the chapter on body handling was, as a trainee, accidentally involved in disaster victim body handling. His senior colleagues, some of them leading figures of British psychiatry, referred him to a chaplain to talk. The chapter on service personnel debriefing points out that debriefing could be harmful. Finally, one chapter emphasizes that debriefing must be regarded as an experimental intervention.

The third section, Adaptations of Debriefing Models, consists of six chapters on issues such as delayed debriefing, debriefing in traumatic birth, debriefing after assaults by patients (interesting, yet not very informative), and debriefing in life-threatening illnesses. The last section, Debriefing Overview and Future Directions, includes four chapters. The two chapters dealing with concerns about debriefing are very interesting, raising such questions as, Can traumatized individuals effectively participate in debriefing? Is acute intervention even necessary? Does trauma have positive aspects? This chapter also questions the possibility of consensus about debriefing. I appreciated the statement that, unlike the stringent scrutiny of the Food and Drug Administration in regard to psychopharmacological treatment, “our profession has gone blithely ahead and subjected thousands of suffering, and nonsuffering, clients, presumed to have psychological wounds, with all manner of intrusive treatment protocols.”

This is clearly an interesting and timely book dealing with a widely used but unproved, questionable, and controversial psychological intervention. The strength of the book is its comprehensiveness, inclusion of multiple and diverse views, and editorial comments at the beginning of each chapter. The weaknesses are the uneven quality of some chapters and the length of the book. Nevertheless, this book will be an important resource for anybody interested in trauma psychology, debriefing, and treatment of psychological sequelae of severe trauma.




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