Debriefing and rebriefing
- info822671
- Mar 15, 2021
- 5 min read
Updated: Mar 6
Third wave?
Many healthcare workers are heaving a sigh of relief after the first 2 waves of Covid-19. At the same time many are struggling due to moral injury, burn-out, depression, anxiety or PTSD. In what ways can debriefing and “rebriefing” help?
You can familiarise yourself with the concept of burn-out, by reading this previous blog post: https://www.helderbergcounselling.co.za/counselling-approach/counselling-for-burnout/
Although anyone in any profession can suffer from burnout, the nature of the medical (and allied) professions puts them at an increased risk for burnout:
Understanding more about PTSD: https://www.ptsd.va.gov/understand/index.asp
Moral injury is the psychological distress that results from the actions, or the lack of them, which violate someone’s moral or ethical code. In the context of Covid-19 it may happen due to a shortage of ventilators – a healthcare worker needs to decide which patients receive the ventilators and who will die. Due to a shortage of PPE a healthcare worker may be forced to stay away from work for his/her own safety and that of his/her family until new supplies arrive. Alternatively, a healthcare worker may decide to go to work, knowing that he/she may put the safety of his/her patients and family at risk. All of this can leave a healthcare worker with enormous internal conflict and guilt.
Although moral injury is not a psychological disorder or diagnosis, it can contribute to the development of disorders, such as depression and PTSD.
Organisational changes
Part of the answer, unfortunately, lies in organisational changes – something over which the individual healthcare worker has little or no control.
That, however, does not mean that efforts to change organisational procedures and policies should be abandoned. As a matter of fact, it is more important than ever before for healthcare workers to stand together to pressure healthcare institutions for structural reforms.
But meanwhile, while the wheels of bureaucracy are turning slowly, what can individual healthcare workers do about their own well-being, within the current structural constraints?
Debriefing
Some healthcare workers will have the need to talk about the trauma they have witnessed or experienced. And if that is the need of an individual, it is important for him/her to find someone they feel comfortable talking to. Some will prefer to discuss it with someone in the same profession or position, feeling that other people might not understand or relate. Others will have exactly the opposite idea – that they want to talk to someone with an outsider’s perspective who are uninvolved and unbiased. Whatever your preference is, find someone you can talk to, whether it is a colleague, friend or counsellor.
This will serve as a form of “debriefing”. For some, this might be a necessary component in dealing with mental health issues. This, however, might not be sufficient.
When people in the same institution (not only health institutions) are experiencing the same issues, these issues are often discussed in length among each other. Often without any positive results or course of action. Consequently, it often leads to bitterness, hopelessness and accentuates the problems.
“Rebriefing”
That is why it so important that there must also be a component of “rebriefing”.
In addition to debriefing or as a stand-alone intervention. This psychological term has been coined to show the contrasts to the features of debriefing.
Debriefing looks at the past, analyses, diagnoses, pathologizes, often points out things nothing can be done about and often tends to cast blame, cause guilt and create hopelessness. Trauma and mistakes are revisited. Consequently, people often get stuck, traumatised or even “paralyzed” after debriefing.
“Rebriefing” looks both at the past (with the aim of identifying coping, skills and resources) and future. “Rebriefing” focuses on what an individual wants, in stead of what he does not want. “Rebriefing” taps into the individual’s strengths, resources and skills. It energises and creates hope and momentum to move forward.
There is a quote from Insoo Kim-Berg that reflects the philosophy of my counselling approach: “There is nothing wrong with you, that what is right with you, cannot fix”. Debriefing tends to focus on the “wrong with you”; “rebriefing” tends to focus on “what is right with you” and “fixing”.
Schedule an appointment with a counsellor or psychologist who understands the value of debriefing (if it is the need of the client), but especially the importance of “rebriefing”.
Guiding questions
Even if you decide not to go for counselling or therapy, here are some questions to guide you and help you “rebrief”:
What is it that you DO want? You do not want to feel depressed/ burnt-out, traumatised, anxious, morally injured etc., but what DO you want?
Suppose you get one step closer to what you DO want…
What would be some of the signs that you are closer to what you want?
Who might be likely to notice it first when you get one step closer to what you want?
Who will be most pleased to see this difference in you?
What might his/her reaction be?
How would you react to their reaction?
If your patients were observant enough, what would they notice that would be different, if you are one step closer to what you want?
If your colleagues were observant enough, what would they notice that would be different, if you are one step closer to what you want?
What difference would it make to you, personally, if you are one step closer to what you want?
What difference would it make to your family and/or friends if you are one step closer to what you want?
What difference would it make to your patients if you are one step closer to what you want?
What difference would it make to _______ (fill in with any significant other not already mentioned) if you are one step closer to what you want?
How have you been able to continue with your duties despite having felt depressed/ burnt-out, traumatised, anxious, morally injured etc?
9.1 What personal qualities or skills did you draw on to continue with your duties despite having felt depressed/ burnt-out, traumatised, anxious, morally injured etc? Or asked in another way, what does it say about you that you were able to continue with your duties despite having felt depressed/ burnt-out, traumatised, anxious, morally injured etc?
9.2 What does it mean to you/what difference does it make right now to know that you possess these qualities?
9.3 What might it mean to you/what difference might it make in the future to know that you possess these qualities?
If you have received help from anyone (or institution) to have continued with your duties despite your struggles, how have you used the help you received, to benefit from it?
Rebriefing
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