Michel BERCLAZ Psychologist-psychotherapist FSP, Qualified in Emergency Psychology and victim support training consultant PSYCHOSOCIAL AND SPIRITUAL SUPPORT DURING AND AFTER CRITICAL INCIDENTS October 2009 © Michel Berclaz : Psychosocial and spiritual support 2009 2 CONTENT WARNING ................................................................................................................................4 1. THE GENEVA INTERVENTION MODEL .......................................................................7 1.1. Means of action...........................................................................................................8 1.2. Types of action............................................................................................................8 1.3. The concept of psycho-social and spiritual support ....................................................9 1.4. Basic principles .........................................................................................................11 2. STRESS .......................................................................................................................12 2.1. Generalities ...............................................................................................................12 2.2. Stress from a biological point of view........................................................................13 2.3. Stress from a psychological point of view .................................................................15 2.4. Stress from an epidemiological point of view ............................................................20 2.5. Severe Stress............................................................................................................21 2.6. Stress and Trauma....................................................................................................23 3. TRAUMA ......................................................................................................................24 3.1. History of trauma.......................................................................................................24 3.2. Definition of trauma ...................................................................................................28 3.3. PTSD : cognitive model and empirical data (Grazia Ceschi Phd)...................33 3.4. Diagnoses .................................................................................................................43 3.5. Types of reactions.....................................................................................................47 3.6. Categories of reactions .............................................................................................48 4. FROM PREMORBIDITY TO RESILENCE ...................................................................50 4.1. Concept of premorbidity ............................................................................................50 4.2. Personality traits and structures................................................................................51 4.3. Neurophysiological base of memory .........................................................................52 5. RESILIENCE ................................................................................................................56 5.5. Impact on the handling..............................................................................................59 5.6. Conclusions...............................................................................................................61 6. FORMS OF INTERVENTIONS.....................................................................................62 6.1. Necessity of immediate and post-immediate psychosocial support..........................62 6.2. Different types of intervention....................................................................................63 6.3. Immediate psychosocial and spiritual support ..........................................................67 6.4. Defusing and debriefing ............................................................................................70 6.5. Objectives of intervention..........................................................................................76 6.6. Limited number of supportive sessions.....................................................................83 © Michel Berclaz : Psychosocial and spiritual support 2009 3 7. PRACTICING PSYCHOLOGICAL DEBRIEFING WITH CHILDREN ...........................88 7.1. Introduction ...............................................................................................................88 7.2. Psychotrauma in Children .........................................................................................89 7.3. Working with Children and Adolescents....................................................................90 7.4. Support for Parents ...................................................................................................91 8. SPIRITUAL SUPPORT.................................................................................................97 8.1. Traumatic shock and spiritual support (Maurice Gardiol & Cosette Odier) .............97 8.2. Of the legitimacy of spiritual support (Michel Berclaz) ........................................100 9. PSYCHOSOCIAL RESPONSES TO CANADIAN DISASTERS 1979-2001:..............103 9.1. Presentation Outline................................................................................................103 9.2. Bring Families Together ..........................................................................................104 9.3. Disaster Funds ........................................................................................................106 9.4. Support Community Initiatives.................................................................................107 9.5. Community-Based Response..................................................................................107 9.6. Lessons Learned in Organizing a Disaster Psychosocial Response Team............108 9.7. Community Response Approach.............................................................................109 9.8. Victim and Helper Profile :.......................................................................................112 10. OCCUPATIONAL HAZARDS AND SELFPROTECTION ...........................................116 10.1. Reactions in intervening professionals ...............................................................116 10.1.1. Identification to the victim .............................................................................117 10.1.2. Identification to the aggressor ......................................................................117 10.2. Professional exhaustion : burnout.......................................................................118 10.3. The mirror effect and triangulation .......................................................................119 10.4. Dealing with stress...............................................................................................122 11. ANNEXES ..................................................................................................................129 10. BIBLIOGRAPHY.........................................................................................................135 © Michel Berclaz : Psychosocial and spiritual support 2009 4 WARNING Macro- and micro-social crises have been ever present throughout the history of mankind. Repeated traumas due to natural disasters (earthquake, volcanic eruption, hurricane, avalanche, flood, famine or epidemics) human error or recklessness (airplane accidents, train, wrecks, fire …) and deliberate acts resulting from the violence that lays rooted in human nature coupled with the complexities of human relationships (criminal assault, domestic violence, rape, torture, hostage taking, terrorism, battle, slaughter, annihilation or relocation of entire populations) are factors that have shaped our past as well as our present, both individually and collectively. An intervention aimed at benefiting people rendered frail by events cannot be applied in all neutrality, void of presuppositions, ambitions (in the broadest sense) and ideologies. The support offered should enable the victims of crises to mobilise, individually and collectively, the resources that are their own, which they can discover through the events, their story, their individual energy and their concern and preoccupation of each other. We do not seek to become predators of others' suffering, nor do we want to name them and in so doing stigmatise and appropriate them to then treat and disappear. In this vein, we refuse to approach the situation as scientists in a science where the victim is the sole object of our study and empirical knowledge (void of the subjectivity) as a precondition to the intervention in its context. The mediator should be an element that intervene at a given point in time and in history, preoccupied by the notion of the victim as subject, the consequences of the traumatised person and the intervention proposed. In all interventions he should keep in mind his future departure, his own absence. The mediator has to support and maintain confidence in the individual and collective resources of the people victimised. Our aim is to find individual and group resources, to identify, validate and support them so that they become the driving force, the motor behind the reconstruction of the subjects and also their solidarity