Debrief Techniques in Crisis Counseling at Ground Zero
I want to describe what it is like to counsel families of those missing at the World Trade Center. Let me first describe the setting where counseling occurs. Families come to the Family Assistance Center, which is a converted Pier on the Hudson River in New York City. This building is huge – five times the size of a football field. There are a couple thousand people inside; about 1,500 are workers of various types and about 500 family members. The families will visit the numerous federal, state, and private agencies: FBI, NY Police, job placement services, Red Cross, and Salvation Army.
I don’t want to rush through their story. Saying, “Tell me more” invites the speaker to fill-in the main points with more details. Have you ever told a story to a person and later wished you could have given more details? The invitation to “tell me more” gives permission to go deeper, provide nuances, side stories that are meaningful, and insights about how the loved one is significant to the storyteller. Getting the full story out to someone who will listen, even though you are a stranger, helps relieve the teller of a burden that aches to be shared and understood. Again it is a human mystery, but when a burdened is shared with another it is lessened in the teller.
The third question considers how the facts and the story are now impacting them. Just asking the obvious question, “How is this affecting you?” is a good starter. I want to keep the question in the present tense because I want to know what is going on right now. To ask it in the past tense, “How did this affect you?” puts the question outside this moment. The better question moves the discussion from the outside/other person focus to the now inside/me position.
Usually the person will tell me they are experiencing a level of pain they never imagined possible. They will use words like loss, empty, void, depressed, suicidal, terrified, and then their words fail them. They have had an experience that cannot be put into words. When a grandparent dies, somehow that feeling of loss is natural and expected. But trauma counseling usually involves a violent event, with evil motives and demonic behavior, leaving survivors unable to comprehend the experience.
Humans make every effort to live in a normal range that is bound by limits we don’t cross. For example, we might drive 70 in a 65 M.P.H. speed zone, but we won’t go past that limit. To drive 120 is incomprehensible. Or we might find our being in poverty intolerable, so we work hard to keep our jobs. A person might be really angry with someone, but they don’t shoot him or her, because that is beyond the limit of their behavior. One might even find their aging to be beyond an unacceptable limit, so they workout, take vitamins, and get a face-lift. This phenomenon is a “limit experience”, a term coined by a philosopher named, Paul Racoiur. He said that humans dread to have an experience outside the limits of normal routines, and these events are incomprehensible. But limit experiences do happen, and not all of them are bad. For example, the conversion of Paul on the Damascus Road was a limit experience given by God.
The answer to the third question will tell me how they are coping with their limit experience. If they answer, “Oh, I’m doing okay”, I know they are coping through denial of their unspeakable pain. If they answer, “I am more concerned about my other relatives than me”; they are minimizing their trauma to cope. If they ask questions, like, “How could God allow this to happen?” they are projecting blame as a way to understand the event. If they express rage at the attackers, like, “I hate the people who did this evil”, they are seeking revenge and hoping to transfer their pain onto someone else. Some will try to strengthen themselves by reassurances like, “God won’t give me more than I can handle.” Whenever I hear this I want to say, “God often gives me circumstances I can’t handle!” but I don’t. Besides their bad theology, they don’t want my help and will take the Lone Ranger approach. When this happens I pause to hear if they do start revealing their pain. Often people will express guilt that they survived, and not the loved one.
All of these responses are God given ways to handle events that they were never designed to handle. I don’t chide them for their coping style. They need comfort, not correction. As people share their pain I don’t say, “I know how you feel”. And don’t even say, “I understand”. If the blunt truth were known, there is only one thing they really want to hear: “I can bring your husband back…alive!” Nothing else satisfies.
Yet even my DNA cries out to say something. My pain reaches its excruciating peak when I realize there is nothing I can say. And whenever I do blurt out something it seems like arrogant pride (hubris). I want to bring healing, but that can come only from God gracious work. But the counselor in me aches to say or do something, anything!
If there were a time I feel basic resentment toward God, it’s when God places me in these impossible paradoxes. As a Chaplain I am the visible symbol of help, yet I seem to be forbidden to help. I am a skilled counselor with nothing to say. I am trained in crisis counseling, but now I am in crisis. I long to help, but I am clearly helpless.
My spirit cries out, “Lord, help me.” And that is the purpose of my pain; the inadequacy drives me to the Lord. The prelude of God working is my clear sense of inadequacy. My weakness is a pre-condition for the release of God’s grace. It’s okay that my inner groaning for words makes me speechless, because then the Spirit in me touches the spirit in the other person. The spiritual counselor has no formula or technique. I have to be helpless before God in order for deep spiritual work to occur. This moment has to be a God thing, not me. When each counseling session starts I know then that God will make me helpless in order to bring help. When I am in this place, the Spirit may prompt me to say something like, “The Lord hears the cry of your heart”, or “God’s heart is broken too”.
The fourth question helps me get back in my head. We humans don’t seem to be wired to stay in soul-extremis very long. Our primal instincts drive us out of such intense agony. As I hear their responses I can back off of the contagious pain that seems consuming and analyze how they are looking to the future.
So the fourth question asks, “What will you do?” The purpose of extreme pain is to prompt action. When the pain level is high enough, people will do something, sometimes anything, to get out of the horrible anxiety. Doing something helps reduce pain. Our culture recommends a variety of poor choices and escape methods to kill the pain like, alcohol, drugs, workaholism, sports thrills, comfort in sex, get revenge, or spend money. Often people are so depressed they are enervated or paralyzed. They maybe stuck and not want to do anything, and maybe they can’t right now. They may feel disoriented because of the traumatic events. These are discussions that don’t lend themselves to a one-time trauma counseling session.
I don’t have to help them figure out their next job or lack of finances, other agencies will help do that. I don’t have to solve legal or health issues; others will assist with those issues. What I can do is something that no one else will do, and that is to help him or her connect with God.
As a spiritual counselor I can ask if I may pray a blessing on the person or family. After making this offer to several hundred people, including New York City Police officers and Firefighters at Ground Zero, everyone is eager to receive it. Even Muslim families welcome a Christian blessing. The act of prayer directs people to the One who can help. Prayer is a spiritual experience that even those far from God are driven to because of their pain. Pain prompts prayer. I reach out to hold hands, and offer a prayer like this: ”Lord, I know you love this person/family and you are hurting right along with them. Please help them get information on their loved one. And I am asking that your hand be on them to guide them through the decisions. Give them strength to endure, and hope for the future. Draw them close to each other and continue to draw them close to you. We give ourselves to you and trust you. We pray in the name of the Father, Son, and Holy Spirit. Amen.”
I tell them I will continue to pray for them. I ask if they have a church they attend and a pastor or priest they can talk to. About half are connected to a church, and I encourage them to continue to seek support from their faith community. If they are not attending a church, I ask if they have a friend who attends a good church they love. Usually they do, so I encourage them to get in touch with their friend and go next Sunday. There is part of me that wants to send them to a Christ loving, Bible teaching, family friendly, compassionate church, but I have to trust God to direct them.
This whole conversation may have taken just 20 minutes or an hour. I have to admit, by this time in the session, I’m done. I feel like I have put in a full day and want to go home. I’m exhausted spiritually, mentally, and emotionally. So, what do I do next?
I get another banana.
By the end of four hours and choking down 11 bananas, I need to stop. Usually the Chaplains will get together to debrief. Three questions will be asked: First, what significant story did you hear? Second, what burden are you carrying inside? And third, what inspired you in the past 4 hours? I know this debrief session is necessary, but as we told one horrifying story after another, we all got traumatized again. We closed with prayer offering our wounds and worries up to God.
I have learned that the accumulation of stories overwhelms my natural strengths and reserves. I’m so emotionally exhausted that I’m not safe anymore, and if I stay, I will say stupid things. There are still hundreds of people in the food court wanting and needing to talk…but I’m done. I have to discipline my messianic urges to help everyone. I feel guilty about leaving, but I have to trust God to take care of them. I need to pray that God would raise up more laborers to work with this harvest. But I still feel guilty…and thrilled that I could be part of a holy work.
Exiting past the military and police guards, I feel refreshed by the cool night air. The two-hour train ride home offers a transition that feels like going from hell to heaven. I am spent and thrilled. All I think about is going home to sleep. It is usually about 2 AM when I arrive and debrief with my wife. She is eager to hear the stories and experiences. She begins the first of four questions.
“Honey, tell me the facts….” The next morning I feel sore and beaten up. Even ten hours of sleep cannot take away the thick grog from head. My wife says I tossed and turned in a disturbed fitful sleep. I dreamt of the surreal images at Ground Zero swirling in my mind as ghostly montages. The frustration of not being able to give tidy, prepackaged answers to eternal questions stimulate a sense of helplessness, and after talking with a couple hundred people that look like you or me, I find myself experiencing a vague survivor’s guilt. I remembered the picture of a missing black pastor, and my having been in the World Trade Center on other Tuesdays, I wondered, “Why his picture and not mine?” The memory of faces and stories race around in my head, refusing to settle into pre-made pigeon holes. There is little in my past experiences that allow me places to fit this calamity.
Since I go in on Monday nights, I purposely plan for a quiet Tuesday at the office. It takes me at least a week to shake off the traumas I heard and imagined in my mind. Even if my trauma comes second hand, the cumulative effect wears and tears at my energy levels and mental sharpness. When the next Monday comes, I feel like my wounds from the previous week are still raw. Paradoxically, I feel dread and eagerness to go back. I have learned to anticipate the cost of hearing the demonic horrors crafted for unsuspecting humans. Yet I am truly privileged to bring the ministry of heaven past the gates of hell. I have probably written more than you wanted, but the writing helped me to debrief and process what is happening to me. I hope it is helpful. Rev. Dr. Toby Nelson
There are lots of mental health workers, and a few Christian Chaplains like me who give spiritual counsel. In between visits with the agencies, family members will gather at the food court to eat and talk. This is the area I work. The first thing I do is grab a banana from a serving table. I walk around for a couple minutes looking for a single person or family not already being helped by a Chaplain. I walk up with a smile and ask if I may join them. From their perspective, it looks like I want a place to sit and eat my banana, and they can tell I am a Chaplain because of the clergy collar I wear. Normally, I do not wear a collar, but in this setting it is a great advantage because it identifies what I am. I am always invited to sit down and join them. I take a chair and ask their names. After the introductions I peal the banana and ask if they are missing a loved one. That question begins a series of debrief questions I use in trauma situations. Debrief questions are often used by counselors in police and fire stations after officers have witnessed a traumatizing situation.
The first question solicits facts. Like the actor Jack Webb used to ask in the old TV series called, Dragnet, he would instruct the hysterical woman, “Just the facts, Ma’am.” Traumatized people are usually disoriented and need to be brought back to physical reality. Asking for their name is a fact question. Asking if they are missing a loved one is a fact question. Asking the name of the victim is a fact question. Asking if the victim was a relative or friend is a fact question. These are easy no-brainer questions that help people center their emotions and focus their scattered attention. For the counselor, it helps understand the context of the events.
Beginning this way helps lower their stress and anxiety because fact questions focus on the reality outside and not the terrors they may be experiencing inside. Asking questions in the present tense “is” rather than past tense “was” is important because it doesn’t rudely force the family to admit their loved one is dead, yet. Their responses of denial or disbelief may still be necessary mechanisms to help cope with a world in chaos. They will come to terms with death when they are ready, and just my safe and comforting presence will facilitate that process. I don’t want to rush through the debrief questions. While I may only spend 15 to 60 minutes, I want to appear to have all the time in the world. My body language is turned toward them. Even my feet point toward them. I need to have my head nod in acknowledgment and my face reflect my feelings of sadness. Paul counseled us to rejoice with those rejoicing and weep with those weeping. I want to manage my countenance to match and keep pace with the speaker. Like us, even God weeps with those who weep, and rejoices with those who rejoice. For example, before Jesus raised Lazarus from the dead, he too wept.
The second question seeks to know “What happened?” This question goes beyond the bare facts to find out the setting and circumstance of the event. I ask the family what kind of work their loved one did at the World Trade Center. This may sound like a fact question, but it begins to put meat on the bare bone facts. Among the hundreds of answers the families always turned a fact into a story: a brother of a victim was in the tower for just a one hour business meeting; the wife of a currency broker on the 104th floor making trades was married less than a year; a firefighter with two sons stayed too long to help others out; a sister of a 42 year old single mother helped get 3 others out she didn’t make it; a young man phoned his father saying, “Dad, I think I’m in trouble and I’m not going to make it out” just before his tower collapsed; a survivor from the 55 floor saw the second jumbo jet head toward him and crash 5 floors above him; a Muslim man worked with his brother on the 66th floor but happened to take the day off. The stories just go on and on. Eliciting the stories is crucial to the debrief process because it helps the teller base the traumatizing event in factual reality. The first question, “Just the facts”, serves as a foundation for answering the second question, “What did the facts do?” The second question goes beyond context and seeks to know what happened in the context. Usually the first explanation just hits the essential points of a fuller story. For the counselor, hearing the story of the loved one begins to draw me in. While factually I am not in the event, mysteriously I become part of the story. Though second hand, the counselor cannot remain indifferent to the story. It is in the nature of a good story, and these are dramatic, that every listener becomes involved on some level. I don’t know how their story gets inside me, the counselor, but it does. This is where their trauma begins to be my trauma; their pain starts to become my pain. This may be second-hand trauma, but it is no less real. Even Paul commented on this dynamic when he wrote, “When one of you suffers, don’t I suffer with you?” By saying, “Tell me more”, I accomplish several things: First, I demonstrate genuine interest in something they desperately want someone to hear. Whereas the FBI and job placement agencies don’t want to hear the stories, just the facts, I want to connect on a much deeper level with the person. Second, people understand and explain life through stories. If I come across as really caring to hear, the teller will tell me fuller parts of the story. Thus I get a greater understanding of their traumas. Third, as the teller feels my safety, they will reveal the more private, personal, and vulnerable parts of how they relate to the story. Fourth, healing occurs in relationship. As the teller trusts my connection, the act of verbalizing the story helps bleed energy off the trauma.