ERIC Identifier: ED315708
Publication Date: 1990-00-00
Author: Thompson, Rosemary
Source: ERIC Clearinghouse on
Counseling and Personnel Services Ann Arbor MI.
Post-Traumatic Loss Debriefing: Providing Immediate Support for
Survivors of Suicide or Sudden Loss. Highlights: An ERIC/CAPS Digest.
Children's suicidal behavior is escalating as America's number one mental
health concern. Suicide intervention and prevention within the context of the
school-as-community does not end with a student's death. School counselors,
administrators and mental health professionals need to develop systematic
strategies to intervene with survivors, as well as potentially at-risk students.
The sudden, unexpected death by suicide or the sudden loss from an accidental
death often produces a characteristic set of psychological and physiological
responses among survivors. Persons exposed to traumatic events such as suicide
or sudden loss often manifest the following stress reactions: irritability,
sleep disturbance, anxiety, startle reaction, nausea, headache, difficulty
concentrating, confusion, fear, guilt, withdrawal, anger, and reactive
depression. The particular pattern of the emotional reaction and type of
response will differ with each survivor depending on the relationship of the
deceased, circumstances surrounding the death, and coping mechanisms of the
survivors. The ultimate contribution of suicide or sudden loss intervention with
survivor groups is to create an appropriate and meaningful opportunity to
respond to suicide or sudden death.
PROVIDING STRUCTURE DURING CHAOS
debriefing is a structured group process approach to help survivors manage their
physical, cognitive and emotional responses to a traumatic loss. It creates a
supportive environment to process blocked communication which often interferes
with the expression of grief or feelings of guilt. It also serves to correct
distorted attitudes toward the deceased, as well as discuss ways of coping with
the loss. The purpose of the debriefing is to reduce the trauma associated with
the sudden loss, initiate an adaptive grief process and prevent further
self-destructive or self-defeating behavior.
Post-traumatic loss debriefing is composed of seven stages: introductory
stage, fact stage, life-review stage, feeling stage, reaction stage, learning
stage, and closure. A debriefing should be organized 24 to 72 hours after the
death. Natural feelings of denial and avoidance predominate during the first 24
hours. The debriefing can be offered to all persons affected by the loss,
however, it is probably most effective with the immediate survivor group.
STAGES OF POST-TRAUMATIC LOSS DEBRIEFING
Stage: Introduce survivors to the debriefing process.
- The counselor defines the nature, limits, roles and goals within the
- The counselor clarifies time limits, number of sessions, and
confidentiality and strives to create a secure environment in which to share
II. Fact Stage: Information is gathered to "recreate the event" from what is
known about it. During the fact phase, participants are asked to recreate the
event for the counselor. The focus of this stage is on facts, not feelings.
- Group members are asked to make a brief statement regarding their
relationship with the deceased, how they heard about the death, and
circumstances surrounding the event. It is important that the group share the
same story concerning the death and that secrets or rumors not be permitted to
divide members from each other. Group processing of the death also provides the
counselor with an opportunity to listen for any attributions of guilt, extreme
emotional responses, or post-traumatic stress reactions.
- Survivors are encouraged to engage in a moderate level of self-disclosure,
with counselor facilitated statements such as, "I didn't know...could you tell
me what that was like for you?"
It is important for the counselor to: (1) try to achieve an accurate sense of
the survivor's world; (2) be aware of the survivors' choice of topics regarding
the death; (3) gain insight into their priorities for the moment; and (4) help
survivors see the many factors which contributed to the death and to curtail
This low initial interaction is a non-threatening warm-up and naturally leads
into a discussion of feelings in the next stage. It also provides a climate in
which to share the details of the death and to intervene to prevent secrets or
rumors that may divide survivors.
III. Life Review Stage: A life review of the deceased can be the next focus,
if appropriate. Zinner (1987) maintains that a life review provides an
opportunity for the group members to recount personal anecdotes about the
deceased. The opportunity to share "remember when..." stories lessens tension
and anxiety within the survivor group. This also serves to ease the acceptance
of the helping professional by the group.
IV. Feeling Stage: Feelings are identified and integrated into the process.
At this stage, survivors should have the opportunity to share the burden of the
feelings they are experiencing in a nonjudgmental, supportive and understanding
manner. Survivors must be permitted to identify their own behavioral reactions
and to relate to the immediate present, i.e., the "here and now."
- The counselor begins by asking feeling-oriented questions: "How did you
feel when that happened?" and "How are you feeling now?" This is a critical
component where survivors acknowledge that "things do get better" with time.
- Each person in the group is offered an opportunity to answer these and a
variety of other questions regarding their feelings. It is important that
survivors express thoughts of responsibility regarding the event and process the
accompanying feelings of sadness.
- At this stage, as in others, it is most critical that no one gets left out
of the discussion, and that no one dominates the discussion at the expense of
others. All feelings, positive or negative, big or small, are important and need
to be listened to and expressed. More importantly, however, this particular
stage allows survivors to see that subtle changes are occurring between what
happened then and what is happening now.
V. Reaction Stage: This stage explores the physical and cognitive stress
reactions to the traumatic event. Acute reactions can last from a few days to a
few weeks. Selected post-traumatic stress reactions include nausea, distressing
dreams, difficulty concentrating, depression, feeling isolated, grief, anxiety
and fear of losing control.
- The counselor asks such questions as, "What reactions did you experience at
the time of the incident?" and "What are you experiencing now?"
- The counselor encourages survivors to discuss what is going on in their
school and/or work lives and in their relationships with parents, peers and
VI. Learning Stage: This stage is designed to assist survivors in learning
new coping skills to deal with their grief reactions. It is also therapeutic to
help survivors realize that others are having similar feelings and experiences.
- The counselor assumes the responsibility of teaching the group something
about their typical stress response reactions.
- The emphasis is on describing how typical and natural it is for people to
experience a wide variety of feelings, emotions and physical reactions to any
traumatic event. Adolescents, in particular, need to know that their reactions
are not unique, but are universally shared reactions.
- Critical to this stage is being alert to danger signals in order to prevent
destructive outcomes and to help survivors return to their pre-crisis
equilibrium and interpersonal stability.
This stage also serves as a primary prevention component for future
self-defeating or self-destructive behavior by identifying the normal responses
to a traumatic event in a secure, therapeutic environment with a caring, trusted
VII. Closure Stage: This final stage seeks to wrap up loose ends, answer
outstanding questions, provide final assurances, and create a plan of action
that is life-centered. Survivor groups often need a direction or specific shared
activity after a debriefing to bring closure to the process. Discussion
surrounding memorials are often suggested and need appropriate direction.
- Survivors should be aware that closure is taking place, therefore, no new
issues should be introduced or discussed at this stage of the debriefing
- The counselor should: (1) examine whether initial stress symptoms have been
reduced or eliminated; (2) assess the coping abilities of the survivors; and (3)
determine if increased levels of relating to others and the environment have
occurred, i.e., are the survivors genuinely hopeful regarding their immediate
future? Are the survivors managing their lives more effectively?
- The group may also close by planning a group activity together such as a
"living task," for example, going to a movie, concert, or similar activity to
promote a sense of purpose and unity.
Ultimately, school counselors are in a unique position to guide intervention
and postvention efforts when a suicide or sudden loss occurs. This debriefing
procedure provides the critical component for restoring school/community
Zinner, E. S. (1987). Responding to suicide in schools: A case in loss intervention and group survivorship. Journal of Counseling and Development, 65(9), 499-501.