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Narrative Therapy Dissertation
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PART TWO |
A Narrative Approach to Critical and Sub-Critical Incident Debriefings |
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A Dissertation by Joel Fay |
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PART TWO
B. STATEMENT OF THE PROBLEM.
Many agencies are now developing Critical Incident Stress Debriefing (CISD) teams (Everly 1995b) to respond to critical incidents as defined by recognized experts in the field of police psychology (Bohl, 1995; Mitchell & Everly, 1996). It is more difficult to identify and respond to the sub-critical incidents or to predict the meanings an officer might attribute to such events. Although there is extensive literature on the subject of CISD, stress and police work and peer counseling, there is little information, if any, on the utilization of a semi-structured intervention format for officers to use "friend to friend." A single exception to this is the ABC method for debriefing as taught by Benner and Quinn (1993). A narrative view would postulate that officers develop a problematic story about themselves to make sense of an experience that does not make sense. Police culture requires the officer to search for the "correct" and "true" meaning of an incident, as defined by the culture, while the post-modern approach views meaning as constructed and therefore continually open to revision. Officers may be unwilling to share their story with anyone other than close friends for fear of possible ridicule subsequent to self-disclosure. It is important that the friend respond appropriately when given the opportunity to help. A fellow officer and friend has the opportunity to challenge the problematic interpretations because she understands the shared-context within the police culture. This project proposes that it is possible to train department members to be more effective listeners and to provide them with some basic skills in peer counseling with a minimum training requirement. The purpose of this study is to design a CISD model with the following attributes: 1) it can be taught quickly and inexpensively to officers, and 2) it would facilitate officers in assisting their fellow officers in the processing of traumatic/sub-critical traumatic events. It is expected that this study will add another tool that can be utilized by police departments in training their officers to assist fellow officers in the processing of sub-critical incidents.
CHAPTER II
REVIEW OF THE LITERATURE
This section will present a representative literature review that will provide background for the study and justify the study's purpose. The literature review has been divided into the following sections: 1. history of police psychological support services 2. police stress, critical incidents and post-traumatic stress disorder 3. critical incident stress debriefings 4. peer support and the police culture 5. attribution of casual meanings 6. narrative theory 7. summary of the literature review The review will show the etiology and the stages of development of law enforcement psychological services. It will also discuss the nature of police stress and how stress interacts with the police culture. Context specific CISD theories and techniques which have been developed to address police stress will be described. Narrative and post-modern theory will be explained as it relates to critical incident debriefing. 1. HISTORY OF POLICE PSYCHOLOGICAL SUPPORT SERVICES For years the only prerequisite to become a police officer was that the officer be of a certain height and weight (Reese & Hodinko, 1990). Police departments refused to look at the psychological needs of its officers for fear that recognizing this need would be detrimental to the department's mission and would encourage emotional instability. This attitude changed as departments became more aware of the detrimental effects of stress and the liability they incurred by placing unsafe and stressed officers on the street (Kirschman, Scrivner, Ellison, & Marcy, 1992). The earliest record of a psychologist assisting with selection of police officers dates back to the early 1900's (Reese & Hodinko, 1990). Although psychologists assisted departments with recruit selection, it took another half-century before the mental health profession would respond to the psychological needs of officers (Reese, 1995). In the 1950's, police employee assistance programs were the first attempts by police departments to help officers maintain and/or improve their mental health. These were generally officer-operated programs and because of police cultural influences did not include the use of mental health professionals (Reese, 1995). Boston, New York City and Chicago police departments all started police-only Alcoholic Anonymous programs (Reese, 1995; Reese & Hodinko, 1990). In 1976, the Boston police department established a stress unit. The purpose of this unit was to help officers cope with personal or occupational stresses that were not necessarily related to alcohol abuse. It was also an attempt to get more officers into the alcohol treatment program by changing the program's name and reducing the stigma that might be attached to getting help with a drinking problem (Reese, 1995). In 1968, the Los Angeles Police Department hired Martin Reiser as the first full time police psychologist (Kirschman, et. al, 1992 & Reese, 1995). In the 1970's the law Enforcement Assistance Administration (LEAA) granted money to larger departments for the purpose of hiring and providing psychological mental health services to police departments (Reese & Hodinko, 1990). In 1971, New York City police officer Harvey Schlossberg, the first known police officer to have earned a doctorate in psychology, became the NYPD's first departmental psychologist (Reese, 1995). Other large departments soon followed with their own police psychologists. The primary purpose of the mental health professionals was to develop and utilize criteria for hiring police officers. It has only been during the past ten to fifteen years that police psychologists also began looking at the issues of police stress (Reese & Hodinko, 1990). By 1986, most of the major police departments in the US had some type of stress unit available to assist officers (Reese, 1995). In addition, some departments are beginning to recognize the stress police work places on officers and their families (Mitchell, 1994). Although the recognition and understanding of police stress is expanding in the larger departments, many smaller departments are still without resources to assist officers after a critical incident (Reese & Hodinko, 1990).
2. POLICE STRESS, CRITICAL INCIDENTS AND POST-TRAUMATIC STRESS DISORDER
In 1963, two Los Angeles police officers were kidnapped while on duty. One of the officers was subsequently murdered while his partner fled and survived. The Los Angeles Police Department (LAPD) ignored the emotional trauma inflicted on the surviving officer and instead concentrated on apprehending the criminals and improving officers' tactics. To accomplish this, the surviving officer's responses during the incident were studied and critiqued. His emotional needs were ignored until he became suicidal (Wambaugh, 1973). While no one, including police administrators, would question the necessity of training and preparing officers for law enforcement's physical dangers, it has taken this type of incident to develop police management interest in preparing officers for the emotional dangers of their work (Dunning, 1990). In the aftermath of this type of incident, police departments began looking at ways to understand police-related stress (Kirschman, et al, 1992). Although there are many definitions of stress in the literature (Kolbell, 1995; Kureczka, 1996; McGrath, 1992;) police stress has been defined as an imbalance between what is required of an officer and what the officer is capable of giving, under conditions where failure may have dire consequences (McGrath, 1992). A stressor can be both positive and/or negative and a person's reaction to a stressor is highly individualized and dependent on the meaning that she attributes to an incident (Alexander, 1994a). How an officer constructs her interpretation of the incident will determine how severe her reaction will be (Everly, 1994a). Research on stress and coping has shown that individuals develop fixed ways of coping with stress in their daily lives. The same ways of coping may at times be adaptive or maladaptive. For example, denial as a coping method may be adaptive at some times, but not at others. Rather than viewing coping as a fixed of rigid "style" or personality trait, the appraisal and coping process is seen as a continuing feedback loop. Factors which mediate one's appraisal of a stressful event may be unique to each individual (Folkman & Lazarus, 1980). A study in Amsterdam showed that of 37 police officers involved in a shooting incident, three had no symptoms, seventeen self-reported some PTSD symptoms and seventeen were diagnosed with PTSD (Ryan & Brewster, 1994). Another study reported that while 4-10% of people who experience a critical incident develop sufficient clinical symptoms to be diagnosed with PTSD, 90% of those involved will develop some emotional, physical or psychological reaction to that exposure (Blak, 1990). A third study revealed that in the week following a shooting, 77% of the surveyed officers reported sleeplessness, 55% reported heightened anxiety, 50% reported flashbacks, 35% reported nightmares and 69% reported feeling tense. Three months later only 35% reported no PTSD symptoms, the remainder reported continuing flashbacks, nervousness and anger (Gund & Elliott, 1995). Police stressors have been divided into four categories (Fuller, 1990): 1. Stressors due to the nature of police work 2. Stressors resulting from departmental policies 3. Stressors dealing with the criminal justice system and societal expectations about police conduct 4. Stressors resulting from psychological issues unique to each officer Selye (as cited in Lawrence, 1984) stated "you cannot study stress; you can merely explore real and tangible things such as (its) effects" (p.248). There are no precise ways to define or measure stress but what has been studied are its effects (Lawrence, 1984). Reactions to stress vary for each officer, but some generalizations have been made. Common reactions include difficulty concentrating, feeling of loss of control, depression, helplessness, fatigue, domestic violence, divorce, impotence, and anxiety (Dunne, 1990; Everly, 1994; Swann & D'Agostino, 1994). Nielson (1986) suggested that there are four primary conditions which determine an officer's reaction to a critical incident. They are: 1) the event is sudden and unexpected; 2) the event represents a significant threat; 3) the events can include an element of loss; and 4) an officer's values or beliefs are challenged. In law enforcement, stressful or traumatic incidents are often referred to as critical incidents. A critical incident is any situation faced by an officer that causes her to experience unusually strong emotional and/or physical reactions. These reactions may have the potential to interfere with the officer's abilities to function either at the scene or later in life (Mitchell as cited in Clark & Friedman, 1992). The officer's reaction to the traumatic event may also interfere with her family life (Sheehan, 1990; Hartsough, 1990). It is important to keep the definition of a critical incident flexible enough to include the various effects an incident has on different officers (FBI Bulletin, 1996). Table 1 lists symptoms of critical incident stress for police officers as adapted from a table designed by Linton, (1993). TABLE 1 SYMPTOMS OF CRITICAL INCIDENT STRESS
During the Event
* Unfocused gaze, the "thousand yard stare" * Suppression and numbing of emotions * Sense disorientation ( time slows down, vision and hearing limited) * Disbelief
After the Event
* Preoccupation with what transpired in scene * Intrusive thoughts and flashbacks * Sleep disturbance and nightmares * Sudden mood changes, anxiety, depression and anger * Difficulty communicating * Withdrawal from coworkers and family * New assignments poorly handled * Routine tasks take longer with less efficiency * Increased use of alcohol or drugs * Feelings of helplessness and guilt
Note: Adapted from Linton, 1993
The first emotional response by most officers in the wake of a critical incident is an attempt to suppress all feelings. An officer has to function with and respond to the internal affairs investigations, reactions from other officers and citizens, and her own family before she can acknowledge her feelings (Lippert, 1990). An officer may also believe that any admission of vulnerability may be used against her in future promotional opportunities or reduce her credibility with fellow officers (Janik, 1990). If an officer continues to suppress her feelings she may cut herself off from those around her and not receive the love and support she needs (Sheehan, 1990). People attempt to cope with new situations by first trying to assimilate the information into their known experience. When that is not possible the person must try to accommodate the new information by creating a new "category" of knowledge. It is our ability to accommodate that allows us to maintain healthy psychological functioning (Gentz, 1990; Wollman, 1993). Officers use a variety of coping methods, some positive and some less adaptive , to deal with police stresses (Hart, et al, 1994). Positive examples include talking with co-workers, obtaining counseling, exercise, etc. (Reese, 1987a). Less adaptive behaviors include alcohol abuse, withdrawing from friends and family and suicide (Beijen, 1995b; Dietrich & Smith, 1986; Seligmann, 1994; Violanti, et al 1985). Officers who feel they can control their situation and environment are better able to handle stress (McCafferty, et al, 1992). However, the nature of critical incidents makes it often unlikely that an officer will have that control (Mitchell, 1996). As conflicts arise between what an officer wants and what is occurring, an officer may attempt to utilize various coping and defense mechanisms (Kurke, 1995). When an officer exhausts her ability to accommodate new information, an emotional numbing develops. Previous held values become meaningless and an officer's ability to cope is diminished (McCafferty, 1992). As an officer works with victims, she is exposed to the ways people violate the trust of other people. As a witness to these violations an officer may question fundamental assumptions about safety and human nature. These assumptions include: 1) people are compassionate, 2) events in the world have meaning and, 3) I am a good person (Janoff-Bulman, 1995). As a consequence, she may become more cynical or suspicious about people's motives (McCunn & Pearlman, 1990). Repeated exposure to direct trauma or vicarious trauma puts an officer at risk for developing PTSD (Fullerton McCarroll, Ursano, Wright, 1992). It is not precisely known why some people develop PTSD and others do not (Braverman, 1992). In 1980, PTSD was recognized as a unique disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Officers are at risk for PTSD not only through direct experience with a critical incident but also as first responders to victims of critical incidents (vicarious trauma) (Wollman, 1993). According to the DSM -IV (1994), PTSD is defined as the development of characteristic symptoms following exposure to an extreme traumatic stressor as the person responds to that event with fear, horror or helplessness (Wilson, 1995). Symptoms experienced include, but are not limited to (DSM-IV):
* Recurrent distressing dreams of the event * Intrusive thoughts of the event * A sense of reliving the experience * Intense psychological distress at exposure to internal or external cues that remind one of the event * Difficulty falling or staying asleep * Difficulty concentrating * Irritability or outbursts of anger * Hypervigilance
In addition, officers may feel symptoms of helplessness, inadequacy, mortality, role-ambiguity, over-identification with victims, guilt and shame (Fullerton, et al, 1992 , Sloan, Rozensky, Kaplan, & Saunders, 1994). According to recent studies there may be a physiological basis for the emotional changes an officer experiences after a critical incident. A study in Boston found that a person's brain structure and chemistry may be affected by traumatic stress. The study determined that when traumatic memories are recalled, a section of the brain called the right amygdala, becomes abnormally active. This part of the brain has been connected to the conditioned-fear response in animals. Current research is focusing on developing a drug that could be effective in the treatment of post traumatic stress and PTSD (Hooper, 1996). An example of the powerful lingering effects from exposure to a critical incident is described by John Britt (1990) a Special Agent with the Secret Service. Britt describes the events surrounding the March, 1981, attempted assassination of President Ronald Reagan. Britt points out that seven years later, a number of agents involved in the original incident continued to have flashbacks, difficulty discussing the event, sleep disorders and other symptoms. Furthermore some of the children of these agents were developing similar symptoms. Nielsen (1990) suggested that there are seven factors that modify a person's reaction to a critical incident. They are: 1) Characteristics of the event: 2) Individual coping style 3) Prior relevant experience and training 4) Degree of warning prior to the event 5) Physical and psychological proximity to the event 6) Concurrent stress 7) Social supports Nielsen suggested that the more skills, training, warning and social supports a person has, combined with a reduction of physical and psychological proximity and concurrent stress, the better the likelihood for a favorable outcome and a reduction in the likelihood of PTSD. In addition to primary PTSD, an officer is also at risk for developing Secondary Traumatic Stress (STS); (Munroe, et al, 1995). STS, sometimes referred to as compassion fatigue, can be defined as the symptoms a person experiences as a result of close contact with a direct victim of a traumatic event (Yassen, 1995). Table 2 lists some of the effects of STS. TABLE 2 The Personal Impact of Secondary Traumatic Stress ______________________________________________________________________ Cognitive Emotional Behavioral Spiritual Interpersonal Physical -Diminished -Powerlessness -Clingy -Questioning the -Withdrawn -Shock concentration -Anxiety -Impatient meaning of life -Decreased Interest -Sweating -Confusion -Guilt -Irritable -Loss of purpose in intimacy or sex -Rapid heartbeat -Spaciness -Anger/Rage -Withdrawn -Lack of self- -Mistrust -Breathing -Loss of meaning -Survivor guilt -Moody satisfaction -Isolation from difficulties -Decreased -Shutdown -Regression -Pervasive friends -Somatic reactions self-esteem -Numbness -Sleep hopelessness -Impact on -Aches and pains -Preoccupation -Fear disturbances -Ennui parenting -Dizziness with trauma -Helplessness -Appetite changes -Anger at God (protectiveness, -Impaired immune -Trauma imagery -Sadness -Nightmares -Questioning of concern about system -Apathy -Depression -Hypervigilance prior religious aggression) -Rigidity -Hypersensitivity -Elevated startle beliefs -Projection of -Disorientation -Emotional -response anger or blame -Whirling thoughts roller coaster -Use of negative -Intolerance -Thoughts of -Overwhelmed coping (smoking; -Loneliness self-harm or harm -Depleted alcohol or other toward others substance misuse) -Self-doubt -Accident proneness -Perfectionism -Losing things -Minimization -Self-harm behaviors Adapted from Yassen, 1995
Niles (1994) postulated that there are four levels of traumatic reaction: Level 1 - Traumatic Reaction - This is the normal response a healthy
person would have to a traumatic incident. The person integrates the information in a way that allows her to function.
Level II - Traumatic Stress Reaction - This is an individual's response to a
life threatening incident. The individual is working through and attempting to integrate her reaction but often requires the assistance of a mental health professional.
Level III - Post-traumatic Stress Reaction - People experiencing this level
of reaction have been unable to successfully process the traumatic event into their lives. They may be experiencing depression, guilt, anxiety, sleep disturbances and other symptoms. A mental health professional is actively involved in assisting the recovery process.
Level IV - PTSD - These people are experiencing the clinical symptoms of
PTSD. A mental health professional should play an expanded role in the recovery process and in-patient care may be required.
The longer treatment is delayed the more extreme the reaction. Police officers who received prompt treatment for traumatic stress exposure averaged two weeks of recovery time before returning to work. Officers in the delayed treatment groups required an average of 46 weeks of recovery before returning to work (Fuller, 1991).
In the 1970's some police departments recognized the need for early intervention. They began to utilize peer support, under the guidance of a mental health professional, to debrief officers after a critical incident. Officers received support from each other as fears and symptoms were normalized and then reduced (Benner, class lecture, 1997). Police psychologists recognized that if an officer did not receive prompt treatment, she would often seal off her emotions. Police mental health professionals began looking for a way to take advantage of the brief window of treatment opportunity (Benner, 1994). Articles appearing in emergency services literature in the early 1970's began to refer to techniques used in the prevention of trauma related disorders (i.e., PTSD) for groups of emergency services personnel involved in a traumatic event (Wollman, 1993). Roberts, a psychologist with the San Jose Police Department first articulated the concept of inoculation training and proposed that this type of training be made a requirement in police academy curriculum (personal communication, Al Benner, Feb. 1998). In 1983, Jeffrey Mitchell described a process known as "critical incident stress debriefing" (CISD) (Mitchell, 1983).
3. CRITICAL INCIDENT STRESS DEBRIEFING (CISD). In today's police environment, a CISD is best described as a structured group discussion based upon crisis intervention theory and educational techniques (Everly, 1995b). It is an intervention for individuals or groups that have experienced a shared traumatic event (Bell, 1995). CISD's are conducted to normalize and minimize an officer's stress reactions to a critical incident (Blak, 1990). The theory on which the technique of CISD is based dates back to combat situations during World Wars I and II (Everly, 1995a). It was found that soldiers who received early crisis intervention near the combat front lines were more likely to return to duty sooner than those soldiers who received help later at a hospital further away from the front (Mitchell & Everly, 1996). Israeli Defense Forces began utilizing psychological debriefings and found that it reduced the incident of psychiatric disturbance by as much as 60% (Mitchell & Everly, 1995a; Mitchell & Everly, 1996). In 1955, American General v. Bailey, a benchmark court case, extended the rights of U.S. workers compensation to employees suffering from psychological illnesses as a result of their work environment. This case encouraged many police administrators to find ways to reduce psychological stress claims (Dunning, 1990). In the 1980's, many police oriented mental health professionals authored articles on critical incident stress and a debriefing process which they utilized in the reduction of stress (Bohl, 1990). In general these processes were based upon the following assumptions (Bohl, 1990; Catherall, 1995; Everly, 1995b):
* The people involved were functioning adequately prior to the event * The symptoms displayed by the individual were a normal reaction to a trauma * The problems were temporary and not based on a personality disorder * The framing of event as a learning and growth experience * The belief that each individual has a unique pathway to recovery * The belief that people should be empowered to be a part of the recovery process
In 1983, Mitchell published a paper describing a six stage model of critical incident debriefing. In 1984, this model was later changed to include a seventh phase (Mitchell & Everly, 1996). The phases and a brief description as listed by Mitchell (Everly & Mitchell, 1995b; Mitchell & Everly, 1996;) are: 1. Introduction: Explanation of roles and expectations 2. Fact: A discussion about "What happened?" 3. Thought: A discussion about "What did you think about what occurred?" 4. Reaction: A discussion about each person's identification of the most
traumatic aspect of the event 5. Symptom: Each person identifies personal symptoms of distress 6. Teaching: Education about normal reactions
7. Re-entry: Clarify questions and resolve last minute issues Since then other authors (Armstrong, Lund, McWright, & Tichenor, 1995; Benner & Quinn, 1993; Bohl, 1990) have listed the specifics of their interventions. Table 3 lists a comparison of these interventions. The goals of a CISD are to alleviate the emotional and physical effects of the incident, accelerate the recovery process, prevent PTSD and return the individual to a pre-crisis level of functioning (Bohl, 1990; Mitchell & Everly, 1996; Wollman, 1993). Critical incident teams began responding to disasters to assist rescue workers both during and after the rescue operation (Armstrong, et al, 1995, Bohl, 1990, Mitchell & Everly, 1995a). It is estimated that at least 300 CISD teams exist internationally. These teams are comprised of emergency personnel, clergy and mental health professionals (Mitchell & Everly, 1995a). Table 3 Comparison of CISD Models
Mitchell Bohl Benner MSD NOVA Introduction Introduction Introduction Disclosure of events Tell about experience Fact Fact Teaching Feelings and reactions Predict emotion Thought Thought Fact Coping strategies Identify coping skills Reaction Feelings Thought/feeling Termination Review session Symptom Symptoms Reaction Teaching Unfinished business Symptom Re-entry Educational Wrap - up Round robin
Note. MSD: Multiple Stressor Debriefing NOVA: National Organization for Victim Assistance An important aspect of a CISD is educational. During this phase an officer's reactions are normalized (Bohl, 1995; Garrison, 1990; Mitchell & Everly, 1996). Inoculation training is another aspect of the CISD educational process (Garrison, 1990). Inoculation training is offered to officers before they experience a critical or sub-critical incident. The goals of inoculation training are to help an officer understand 1) the meaning an event can have on them; 2) explain ways to re-establish control over their lives after an event; and 3) to explain possible reactions as a normal part of the critical incident process (Garrison, 1990; Solomon, 1990). Two additional models of CISD require explanation. These models differ from the previous models as they are designed to be utilized with individuals instead of groups. These are the Safe-R model designed by Everly (1994) and the ABC model designed by Benner & Quinn (1993). Everly lists the following steps in a SAFE-R Model (Everly, 1994; Mitchell and Everly, 1996): Step One - Stimulation Reduction Step Two - Acknowledgment of the crisis Step Three - Facilitation of understanding and normalization of symptoms/reactions Step Four - Encourage effective coping techniques Step Five - Restoration of independent functioning or provision of after care.
Benner and Quinn list the following steps in the ABC model (Benner/Quinn, 1993) Step A - All the way through without interruption Step B - Back through with thoughts/reaction and feelings
Step C- Confront (points of discrepancy, magical thinking, excessive self-criticism, etc.); Calm and Continuity (what previous experiences are similar?).
Table 4 Benner/Quinn ABC Individual Debriefing Model
The SAFE-R and the ABC models are both designed to be used by trained peer counselors or mental health professionals (Everly, 1994, Benner & Quinn, 1993). How does the CISD process provide relief for police officers? Studies have shown that an intervention that is prompt, provides cathartic relief, recognizes cognitive factors and has elements of peer support is an excellent way to assist officers (Bohl, 1995). A study of Australian police officers (Evans, Coman, Stanley, & Burrows, 1993) found that police officers utilized problem focused and direct action strategies to deal with occupational stress. A CISD has the intervention factors listed above and uses direct action and problem focused strategies (Bohl, 1995; Mitchell & Everly 1996). The San Jose Police Department (SJPD) has demonstrated the effectiveness of their CISD team. Between 1972 and 1987, a period when they did not have a CISD team, 52 officers were involved in shootings and 17 of those officers subsequently left the department. Since the inception of their CISD team, 122 officers have been involved in shootings and none of these officers have left the department (Benner, 1994). Another study compared the outcome of two aircraft disasters, the 1978 San Diego airplane crash and the 1986 Cerritos airplane crash. These disasters were similar in the numbers of victims, homes destroyed, and civilians killed on the ground. In San Diego, mental health professionals provided individual counseling while in Cerritos twelve critical incident stress debriefings were conducted with follow-up care provided. In San Diego five officers, seven fire fighters and fifteen paramedics resigned within one year of the accident. There was also a 31% increase in mental health utilization by employees. Cerritos lost no firefighters, no police officers, one paramedic and employees experienced a 1% increase in mental health services use (Everly & Mitchell, 1995b). A study conducted by Bohl (1990) compared two groups of officers involved in similar stressful incidents from different departments. She found that the group that received CISD intervention was significantly less angry and depressed and had milder stress symptoms. Both groups had similar anxiety levels. Robinson (as reported in Mitchell, 1990b) surveyed a group of officers who participated in a CISD. He found that 75% of the officers involved felt that the debriefing was moderately to extremely helpful and no one reported any negative effects from the debriefing. While these numbers are significant, there are some inherent difficulties with evaluating the effectiveness of CISD's. Comparison studies, which involve two groups of individuals who experienced the same traumatic event, but receive different treatment, are difficult to find (Bisson & Deahl, 1994). Police departments are naturally reluctant to provide different treatments because of liability factors. This reluctance makes it difficult to use control group research designs. Other studies had methodological problems that make it difficult to be certain about conclusions (Kolbell, 1995). Bisson and Deahl (1994) conducted an analysis of published studies. Their investigation showed that, at best, a CISD offers some protection against the development of PTSD and at worst it does no harm. A review of the literature found no references to CISD which utilized approaches informed by narrative ideology.
4. PEER SUPPORT WITHIN THE POLICE CULTURE Social or peer support is seen as a very important part of the police culture (Graf, 1986, Benner, 1982). It is believed that a supportive environment helps trauma survivors recover by normalizing and legitimizing their reactions. Without social support, an officer would have no way to conclude that her reactions were normal and would instead try to suppress her feelings and emotions (Braverman, 1992). One of the most important elements of a CISD is the normalization of feelings, behaviors and thoughts (Armstrong et al,1995; Bohl, 1995; Evans et al 1993; Everly, 1995b; McCammon & Allison, 1995; Mitchell & Everly,1995a; Wollman, 1993) yet most officers don't seek help dealing with the emotional impact of a critical incident (Ochberg, 1995). Reasons vary from the previously described "John Wayne" syndrome (Linden & Klein, 1988; Skultety & Singer, 1994) to basic mistrust of the mental health profession (Benner, 1982). Bradstreet (1994) suggested that emotions are debilitating for police officers because they focus attention inwardly rather than out toward possible danger areas. Further, within the police culture there is a "training" process where senior officers joke with and tease new officers probing for sensitive areas. New officers learn quickly not to allow emotions or these sensitive areas to show. Narrative or post-modern approaches emphasize the influence of dominant and sub-dominant cultures on an individual's beliefs, values, and sense of self. The police sub-culture features strongly held values that may differ from values held in the dominant culture; values which influence the officer's reaction to traumatic events. Officers learn the importance of being "one of the group" while in academy training. They believe that survival, professionally and on the street, depends upon being accepted and supported by the police culture (Graf, 1986). The law enforcement mission requires officers to maintain a strong loyalty bond with other officers (Gund & Elliott, 1995). Another widely held belief is that because police work is unique, only police officers can understand the nature of police job stress (Bradstreet, 1994; Hays, 1994; Reese, 1984). This belief convinces the officer that she has to rely on peer support to help her recover from and validate her experience of a critical incident (Benner, 1982; Evans et al, 1993). Officers also believe that their role in society is paternal, that they must take care of others without expecting to be taken care of themselves (Beijen, 1995b). Another constraining belief among officers is that it is important not to express their emotions, to look strong and remain in control (Reese, 1990). The police culture strongly suggests that officers block or deny an event's psychological impact (Braverman, 1992). Further complicating the situation is that people often feel vulnerable after a traumatic event and may be less anxious to share their thoughts and fears (Braverman, 1992). These beliefs make it difficult to reach out for help. It is the conflict between the necessity of remaining in control during work hours and the wish to express emotions to aid recovery after work that causes difficulties (Benner, 1982). But officers do talk about their experiences with other officers and friends (Alexander, 1994b; Beijen, 1995a). While it is rare (Dunning, 1990) for an officer to need the help of a mental health professional after a stressful incident, most officers utilize an informal process of debriefing with peer counselors and friends. A study by Lt. Dirk Beijen, SFPD, (1995a) attempted to determine to whom a veteran police officer is most likely to turn for help. His results showed that 80% of the responding officers would seek help from a fellow officer and friend, but only 35% would seek help from a peer counselor. The majority of officers would, if necessary, seek out a friend for an informal debriefing. In another study (Alexander, 1994b) officers were asked to list the methods that they used to ward off the effects of on-duty stress. Seven percent said they would seek spiritual or religious help, six percent said they would talk things over with a counselor and fifty nine percent said they would talk things over with a friend or family. It is interesting to note that forty percent said they would increase alcohol consumption. Wollman's (1993) study showed that in crisis situations it is best to select peers for debriefing from the same cultural groups as the people involved in the crisis. Members of a cultural group, such as police, share an awareness of history, rules and values not shared by outsiders. In narrative ideology this would be called a local knowledge or dominant narrative (White & Epston, 1990). Social support has been shown to promote recovery from trauma and act as a buffer against stress (Braverman, 1992; Foreman, 1994; Kaufmann & Beehr, 1989). Police culture provides officers with an understanding of shared values and ethics which best allow the normalization process to be accomplished through the use of peer support (Kirkcaldy & Cooper, 1995). Reese (1984) defined peer support as: A process whereby officers who feel a need to communicate their feelings about their jobs, their homes lives, or a combination of the two, may do so with officers trained to assist or refer. (p. 66)
Cobb (1974) defined peer support as: Information leading the subject to believe that he is cared for and loved, esteemed and a member of a network of mutual obligations. (p. 300)
The use of peer support in law enforcement dates back to the mid 1950's when the Chicago police department used peer support to deal with alcoholism. Other departments soon followed (Klein, 1990; Reese, 1995; Reese & Hodinko, 1990). The use of peer support expanded to cover police related stress and officer involved shootings (Reese & Hodinko, 1990). Throughout the 1970's and 1980's many departments began to develop peer counseling programs (Klein, 1990). Most peer counseling programs are based on four assumptions (McMains, 1990). They are: 1) officers are normal people working in an extraordinary profession and not extraordinary people working in an ordinary profession; 2) peer counselors have more credibility because they know what the job is like; 3) early intervention is the best prevention of PTSD; and 4) peer counselors are available 24 hours a day, 365 days a year. Peer counselors were soon given the additional responsibility of assisting mental health professionals or conducting CISD's on their own (Mitchell & Everly, 1995). Peer counselors are a vital part of a critical incident team because of the assistance they provide in education and normalization of feelings (Mitchell, 1990b). Trust is viewed as the most important component of a therapeutic alliance. But officers are known to have problems trusting people (Silva, 1990) and trauma exacerbates a officer's ability or desire to trust ((McCunn & Pearlman, 1990). A problem arises when a peer counselor is not viewed by a traumatized officer as someone she can trust, or when the window of opportunity to intervention is only offered to a non-peer counselor friend. It is not feasible for any police organization to have every departmental member attend a minimum six days of training in peer counseling and critical incident debriefing (California Police Officer Standardization of Training, 1996).
5. ATTRIBUTION OF MEANING Since each person reacts differently to a stressful event, it is not possible for one intervention to be equally effective with all people. (Mitchell, 1994b). Factors influencing an officer's reaction include the department's attitude, the news media, the meaning an officer ascribes to an incident, and current stressors in her life (Klein, 1990; Ryan & Brewster, 1994). Some individuals may have stress reactions almost immediately following an event and others may experience delayed reactions (Reese, 1990). Low magnitude stressors or sub-critical events, which may not be perceived as "objectively" stressful, may be seen by participants as highly stressful and problematic (Garrison, 1990; Litz & Weathers, 1994). Further complicating the ability to predict the impact of a traumatic incident is that it rarely stands alone in the officer's experience (Ostrov, 1990). In addition, an officer may be under a great deal of stress from factors unrelated to police work and the exposure to a sub-critical incident may overburden the officer's already taxed coping abilities (Nielsen, 1996). Some officers believe that it is important to develop an emotional callous which allows them to maintain their composure and psychological balance when confronted by a traumatic event. This protective shield, which grows thicker with increased exposure to critical and sub-critical incidents often alienates an officer from his family, friends and support groups (Reese, 1987a). The meaning an officer attributes to an event comes from socially constructed ideas an officer has about the "correct" way to respond. The beliefs are constructed within the dominant societal and police cultures. It is the meaning or interpretation that determines the officer's behaviors and reactions after the event. (White & Epston,1990; Everly,1994a). The subjective perception of how and why an event occurs is referred to as an individual's explanatory style. According to Seligman (1995) people have a tendency to offer similar types of explanations for different events over time and he refers to this trait as an explanatory style. Seligman suggests that people have either a pessimistic or an optimistic style. A person with a pessimistic style would develop an internal explanation (personal) that involved self-blame, a stable-explanation, which refers to long-lasting causes (permanent); and/or a global explanation, which would have a pervasive cause. A person with an optimistic style develops an external explanation, an unstable explanation, which refers to short-term causes, and a specific explanation. Understanding the meaning of a critical incident is a difficult task for most police departments (Mitchell, 1994b). The difficulty lies in the fact that there can be more than one meaning for the involved officers. Departments rely on pre-written policies to facilitate the operation of the organization. When an incident falls outside the recognized guidelines an officer may not get the organizational help she needs (Ryan and Brewster, 1994). An officer may only have been a witness to an incident, but as a result of what she saw could experience shame at her reactions (or lack of reactions) and feel she failed to live up to the appropriate cultural expectations of a police officer (Garrison, 1990). Although the officer's experience may not be formally recognized for its traumatic implications, she still may turn to friends for help and understanding.
6. NARRATIVE THEORY: Current CISD practices are based on the belief that police officers prefer to utilize problem focused and direct action strategies to deal with occupational stress (Evans et al, 1993). A CISD provides prompt cathartic relief but maintains a strong focus on cognitive factors (Bohl, 1995). Typical CISD questions focus on the facts surrounding the incident. Some examples of these questions are: 1. When you went off "auto-pilot" what was the first thing you noticed? 2. What was the worst part of the incident for you? 3. What was the best part of the incident for you? Narrative theory emerges from the milieu of post-modern thought. According to Freedman and Combs (1996), post-modern ideology has four essential beliefs. They are: 1. Realities are socially constructed 2. Realities are constituted through language 3. Realities are organized and maintained through narrative 4. There are no essential truths
Narrative theory would postulate that officers develop a story about themselves and their reactions to a critical incident. Officers may see themselves as heroes or cowards depending on the meaning they attributed to their experience of a critical incident. They construct a self-story to make sense of all experiences, including those that do not make sense (Freeman & Combs, 1996). Officers may select out aspects of the critical incident that conforms to their dominant problematic story and overlook or minimize aspects that do not conform. Although a particular event may occur in time, the meaning ascribed to it may be generalized beyond the specific event and influence the officer's sense of self (White and Epston, 1990). As Edward Bruner (1986) stated, "Stories make meaning" (p. 140). The post-modern, narrative social constructionist view of reality is that there are no essential truths (Freedman & Combs, 1996; Smith, 1997). However, police work deals with black/white issues. Officers need to make rapid decisions to determine "right" from "wrong" and "safe" from "unsafe." Police discourse demands that police officers determine "the truth" in ambiguous situations (Hays, 1994). The police culture may covertly support an officer's maladaptive behaviors that are often a result of a critical incident. These behaviors may include excessive drug/alcohol use, withdrawal from friends and fellow officers, poor work habits or difficulty relating to the public (Linton, et al, 1993; Smith & de Chasnay, 1994). Police culture overlooks the social or psychological context of the behaviors. White, a co-developer of the narrative therapeutic approach, uses a post-modern perspective to explain how thoughts and feelings are ascribed meaning. White stated (1989): In striving to make sense of our lives, we face the task of arranging our experiences of events in sequences across time in such a way as to arrive
at a coherent account of ourselves. Specific experiences of events of the
past and the present, and those that are predicted to occur in the future, are connected to develop this account, which has been referred to as a story or self-narrative (p.32). Narratively speaking, a CISD examines how officers interpret their actions, feelings and behaviors (Gergen, 1985) and challenges a problematic self-view of an officer's performance through education and peer support. Narrative therapy utilizes an approach often referred to as externalizing conversations. This approach allows a person to view the problem as a separate from herself making it easier to recognize, understand and protest its influence (White & Epston, 1990). Externalizing helps people avoid becoming overwhelmed by a problem (O'Hanlon, 1994). Separating the problem from the individual does not relieve the person of the responsibility for the ways in which they participate in the maintenance or resolution of the problem (White & Epston, 1990). During a CISD the negative effects of critical stress are identified and "externalized" allowing the officer to see the effects as a normal reaction to an abnormal event (Foreman, 1994; Mitchell & Everly, 1995a; Van der Kolk, 1990;). In effect, the problematic behaviors and the meanings attributed to those behaviors are identified as belonging to the critical incident and not the officer. These meanings are also influenced by the constraints of the police culture. Narrative approaches do not seek to establish a universal truth (White & Epston, 1990) but rather to take into account the meaning and stories about the meaning each officer brings to the equation. A peer based CISD model would support the belief that everyone's reality is equally valid.
7. SUMMARY OF LITERATURE REVIEW
The literature review has described the evolution of critical incident stress theory. This field of study evolved from an identified need within law enforcement to provide officers with stress reducing skills. Most law enforcement mental health practitioners utilize a variation of a Critical Incident Stress Debriefing (CISD) process, as popularized by Mitchell, to assist officers after a critical incident. The function and purpose of the CISD is to normalize and reduce an officer's reaction to stress. Research has shown that the CISD process is successful at reducing long-term psychological problems resulting from exposure to a traumatic event. Peer counseling is an important part of a CISD. The use of peers allows for the sharing and normalization of symptoms and provides an avenue for inexpensive, available and trusted follow-up care. Because it is difficult to determine the meaning an officer will ascribe to an event, many officers are not given the opportunity to participate in a critical incident debriefing. These officers either turn to fellow officers and friends for help with processing the event or try to stand alone and "tough it out." Standing alone may lead to negative coping behaviors such as substance abuse, domestic violence and suicide. Most officers are not trained to help their colleagues in a time of psychological crisis. Narrative approaches may provide a base on which to develop a "street-friendly" and teachable protocol which officers can use to assist their colleagues.
CHAPTER III METHODS
A. Research Question Can an easy-to-utilize and inexpensive intervention be developed which can be taught to officers that would allow them to assist individual colleagues with the processing of traumatic, critical and sub-critical incidents?
B. Research Design
Design Statement: This study was a interactive qualitative process involving the sequential incorporation of feedback from community mental health workers, narrative therapists, police officers and citizens into a "seed" statement which was derived from the research question. The project was a formative evaluation of a new peer-based intervention model which addressed the issue of stress reactions to sub-critical incidents in law enforcement. The goal of this project was to improve the psychological well-being of law enforcement officers. The process utilized for developing this intervention is divided into three sections. They are:
1. Problem Identification.
A. What is the problem? B. For whom is it a problem? C. Is the problem important enough to justify? 2. Alternative Problem Resolution Strategies .
A. What efforts have been taken to resolve the problem? B. What new efforts should be utilized? C. What resources are required? D. How will the alternative response be taught and evaluated? 3. Program Recommendations.
A. How does the program operate? B. What is required to implement the suggestions?
C. Recommendations for follow-up research.
C. Research Procedure: To assist with the explanation of the project this section has been divided into the following sub-sections: 1. Explication of existing models 2. Integration of narrative concepts CISD models and police stress will be briefly reviewed and combined with a discussion of narrative theory. Specific details for conducting this study will be outlined.
1. Explication of Existing Models: Although different group CISD models vary from one another in certain aspects, they also have a number of factors in common. These similarities include fact finding, determining thoughts, reactions and symptoms, education, and re-entry. The goal of a CISD is to normalize an officer's response to a traumatic event. The group milieu is an important part of this process because it incorporates peer support into a structured group intervention. The individual or one-to-one CISD models discussed earlier simplify the CISD process but also rely on trained CISD personnel to conduct the debriefing. The drawback to the SAFE-R model is that it is designed to be used for officers involved in clearly identifiable critical incidents while sub-critical incidents can and most likely will be missed by CISD providers. Benner's ABC model offers more flexibility. A sub-critical incident can be defined as an event that may not be perceived as traumatic to a majority of officers or as an event that falls outside the traditional or officially defined parameters of a critical incident. However it is an event which is capable of causing a stressful emotional impact in an individual due to the meaning(s) a person ascribes to that event. Because of the cultural beliefs within the law enforcement community, an officer may not feel it is safe or appropriate to talk about his/her stress reaction to sub-critical events and may try to "tough it out" alone. The group and individual CISD models outlined earlier contain proven steps and procedures for effectively reducing maladaptive reactions to stress induced by police work. The intent of this project is not to disregard the important aspects of established CISD models but rather to infuse the generalized CISD model with concepts derived from narrative theory to create a new model designed to be used for sub-critical incidents. The new model could be referred to as a Sub-Critical Incident Stress Debriefing (SCISD).
2. Integration of Narrative concepts: Narrative ideology, as utilized in critical incident debriefings, could add another dimension to the CISD process. Narrative or post-modern approaches emphasize the influence of dominant cultures on an individual's beliefs, values, and sense of self. A narrative view would postulate that officers develop a story about themselves and their reactions to a critical incident. Through a Narrative approach a problematic story could be challenged and an alternative, non-problematic story, enhanced. By identifying and addressing an invalidating dominant police-culture belief an officer could choose to accept or reject it. Narrative approaches also offer opportunities for the externalization of symptoms. In current CISD process, symptoms are identified as a normal part of the recovery process however an officer could decide that a symptom "belonged" to an incident and not to the officer. This process could allow the officer to take a stand against the symptom rather than be a carrier of the symptom. As a part of this practice officers could name and identify stress reactions, discuss the negative effect on their lives of these reactions, and identify the ways in which they have been able to take a stand against the symptoms.
D. Evaluation of a Narrative SCISD Model:
The evaluation section is divided into three sections. These sections are: 1. Curriculum 2. Curriculum presentation 3. Evaluation
1. Curriculum: The curriculum is divided into three sections. It is based in theory on Benner/Quinn's ABC intervention model. These sections are: I) All the way through; II) Establishing a mutual understanding; and III) Finding alternative possibilities. Questions that can be utilized by the interviewing peer-officer are provided with each section. In this section the word "intervention" will refer to the sub-critical incident debriefing model and the word "curriculum" will refer to the presentation and teaching of the debriefing model.
I. All the way through:
* Allow the officer to tell the story of the incident from beginning to end with
few interruptions.
2. Interruptions should be only to clarify information.
II. Establishing a mutual understanding about the incident: (What did the event cause the person to believe about himself?)
1. As you think back on this incident what aspect of the event effected you the
most?
1. What message or belief did you receive about yourself as a result of your
experience?
3. Where does this belief come from? a. How were you introduced to this belief? b. Have you known people who shared this belief? c. I what context have you known these people? 4. Who would support that belief? 5. Why? 6. Who would oppose it? a. Is there someone you respect that would oppose this belief? Who? 7. Why would they oppose this belief? 8. What other possible messages could you have received? 9. Repeat questions D-G as necessary.
1. In regards to this incident, what would this belief want you to believe about
yourself?
11. How did the incident convince you of this belief? 12. If you accepted these beliefs as true what effect would that have on your life? 13. Do you consider this effect to be positive? 14. Do you consider this effect to be pro- name or anti-name
III. Finding alternative possibilities to the story. 1. How would you rather have had this incident (the negative one) have gone? 2. What were your options? 3. Can you think of a time when you were at your very best as a police officer? 4. What did you do that made you feel you were at your very best during the situation? 5. If I were watching the (very best) incident, what would I have seen? 6. What did this (very best) innocent get you to believe about yourself? 7. If you were to have viewed a film of the negative incident, but your twin brother was involved, how do you think you would interpret his actions? 8. How could your understanding of the past positive belief/incident help you today with your understanding of this (negative) incident 9. How is this helpful? 10. How do you think this new knowledge will change the beliefs you received from the (negative) incident?
2. Curriculum Presentation The Narrative SCISD model was first utilized with three volunteer subjects who were asked to provide feedback about the intervention's format and content. The intervention was then modified. The SCISD model was then presented to several groups. These groups included volunteer officers, some of whom had received prior training in CISD and some who had not received previous training; therapists trained in narrative therapy and therapists working in the community mental health field although not necessarily with experience in CISD. The curriculum presentation took approximately four hours. It was presented in a classroom setting and included didactic and experiential components. An outline of the class is presented below.
Curriculum
I. Introductions and explanation of the research goals. II. Playing of a five minute audio tape of recorded police dispatch tapes of high stress incidents.
1. Participants will be asked to pay attention to their own physical,
cognitive and emotional responses. 2. Participants will be asked to list responses and their list will be
compared with a list of reactions previously reported in this study.
I. An explanation of critical incident stress and the ways it effects a person's world view. II. An explanation of a sub-critical incidents. I. A discussion on the importance of peer support II. Review and explanation of the curriculum III. Demonstration of the curriculum (video or audio tape) IV. Experiential component:
Each participant will be paired with another participant. Each will be
asked to interview the other about a personal incident utilizing the curriculum. Each interview will last fifteen minutes.
I. Conclusion and final questions.
3. Curriculum Evaluation A. Response From Participants: Participants were asked to provide qualitative and quantitative feedback about the content and format of the SCISD training. The quantitative feedback was in the form of a questionnaire they filled out at the end of the presentation and which address specific areas of the curriculum. The qualitative feedback was obtained in an open discussion after the presentation. The questionnaire (Appendix B) was provided to each participant. It covered the following areas: curriculum, intervention strategy, perceived difficulties with implementation, use or acceptance, efficacy (How will the participants know the intervention made a difference?)
E. Construction of the New Model The evaluative feedback received from the reviewing participants was incorporated into the final version of the SCISD model according to construct validation techniques commonly employed following formative evaluation procedures.
F. Operational Definitions
1. Critical Incident. An event which challenges an officer's world view and produces a temporary state of psychological unbalance and emotional turmoil (Mitchell, 1983). The event has a stressful impact which sometimes overwhelms the usual coping skills of the officer (Mitchell & Everly, 1996). 2. Critical Incident Stress. The reaction a officer has to a critical or sub-critical incident (Mitchell & Everly, 1996). 3. Post Traumatic Stress Disorder (PTSD). A psychiatric disorder which may result from exposure to a critical incident or traumatic event (APA, DSM, 1994). 4. Critical Incident Stress Debriefing (CISD). A meeting or discussion with a group or a single individual for the purposes of discussing a critical incident, normalizing physical and psychological reactions, education and peer support (Mitchell & Everly, 1996; Benner & Quinn, 1993.) 5. Critical Incident Stress Team. Mental health professionals, clergy and peer support personnel, working together to intervene and reduce maladaptive stress reactions in police officers (Mitchell & Everly, 1996). 6. Peer Support . Officers, assisting other officers, in times of crisis, with the goal of normalizing feelings, physiological and psychological reactions and providing support. 7. Sub-Critical Incident. Any event that falls outside the traditional or officially defined parameters of a critical incident, but which has emotional impact on an individual due to the meaning a person ascribes to that event. 8. Sub-Critical Incident Stress Debriefing (SCISD). A semi-structured intervention with an individual for the purpose of enabling a discussing about a sub-critical incident, normalizing physical and psychological reactions to that incident and peer support.
CHAPTER IV
Formulation and Evaluation
This study was designed to determine if an easy-to-utilize and inexpensive intervention could be developed which when taught to police officers, would allow them to assist colleagues with the processing of traumatic, critical and sub-critical incidents.
This chapter with be divided into the following parts: 1. Intervention Formulation and Evaluation 2. Curriculum Formulation and Evaluation 3. Delimitations 4. Implications for Future Research and Clinical Practice The intervention formulation and evaluation section will detail how the intervention was constructed and document the evolution of the intervention into its current form. The methods used to formatively assess the curriculum and provide examples of participant feedback will be discussed. The delimitations section will address the limitations of this study. The implications for future research and clinical practice section will provide suggestions for areas of possible future research and effectiveness evaluation.
Intervention Formulation: This intervention was first designed by interviewing a volunteer subject about a sub-critical incident which he had been finding difficult to resolve. The subject understood that the purpose of the interview was to assist in the formulation of a narrative debriefing model. Informed by postmodern practices, I deconstructed the interview by asking the subject why he responded a particular way to particular questions and how I might have obtained alternative responses. Based upon his feedback, I tried new questions and formats. This intervention is presented in Table 5.
Table 5 Intervention Version I ________________________________________________________________________
I. All the way through:
* Allow the officer to tell the story of the incident from beginning to end with
few interruptions.
2. Interruptions should be only to clarify information.
II. Establishing a mutual understanding about the incident: (What did the event cause the person to believe about him/herself?)
1. As you think back on this incident what aspect of the event affected you the
most?
1. What message or belief did you receive about yourself as a result of your
experience?
3. Where does this belief come from? a. How were you introduced to this belief? b. Have you known people who shared this belief? c. In what context have you known these people? 4. Who would support that belief? Why? 5. Who would oppose it? a. Is there someone you respect who would oppose this belief? 6. Why would he/she oppose this belief? 7. What other possible messages could you have received? Table 5 continued:
8. Repeat questions as necessary.
9. In regards to this incident, what would this belief want you to believe about yourself?
10. How did the incident convince you of this belief? 11. If you accepted these beliefs as true what effect would that have on your life? 12. Do you consider this effect to be positive?
1. Do you consider this effect to be pro "person's name" or anti "person's
name?"
III. Finding alternative possibilities to the story. 1. How would you rather have had this incident (the negative one) go? 2. What were your options? 3. Can you think of a time when you were at your very best as a police officer? 4. What did you do that made you feel you were at your very best during the situation? 5. If I were watching the (very best) incident, what would I have seen? 6. What did this (very best) incident get you to believe about yourself? 7. If you were to have viewed a film of the negative incident, but your twin brother was involved, how do you think you would interpret his actions? 8. How could your understanding of the past positive belief/incident help you today with your understanding of this (negative) incident 9. How is this helpful? 10. How do you think this new knowledge will change the beliefs you received from the (negative) incident?
In Part I of the intervention, I am interested in hearing and understanding the facts about the incident. I try not to interrupt the interviewee; questions are asked for clarification only. In Part II, I am interested in discovering the meaning an officer attributes to the facts. I am looking for the linkage between the events and ways the officer makes meaning of the events. I am also interested in the history of the negative/problematic belief or story in the officer's life. In Part III, I am searching for unique outcomes, times when the officer's life was not influenced by the problem. I then create an ego dystonic relationship between the officer and the problematic belief. The officer and I then generate "meaning options" and discuss how the change in meaning might affect the officer in the future. Prior to presenting the curriculum to a group, the intervention was presented to three volunteer subjects. Two of these subjects were officers and one was a civilian. These subjects were interviewed about an actual critical or sub-critical incident which they had experienced and which they were finding difficult to resolve. After the interview the subjects provided information about the intervention content and process; this feedback/deconstruction was utilized to modify the intervention. I also sent copies of each transcript to David Epston, an expert in the field of narrative psychology, who also provided feedback from a narrative perspective. The changes to each version were made as a result of my analysis and deconstruction of each interview, and David Epston's feedback. The changes are shown immediately after the interview and have been italicized and highlighted in bold print. In this chapter, I will use relevant excerpts from these interviews to illustrate various parts of the intervention. Interview #1 utilized Intervention version I during the interview process.
Interview #1 This interview was conducted with a police officer who agreed to discuss a shooting incident he had been involved in 17 years ago. The incident still bothered him. The names of the involved parties and locations in all three interviews have been changed to preserve confidentiality.
I. All the way through: Q: I would like you to go over the story of the incident from beginning to end.
A: There were three officers that were drinking at the 4th Street Bar. One was a local officer named Bob and he was drinking with a state and a federal narcotics agent at the bar. Around the corner was another bar and an off-duty rookie from another department was drinking with a military policeman at that bar. The rookie was black and the other officers were white. Everyone came out of the bars at the same time. The rookie realized that he couldn't find his wallet so he started crawling on the ground looking for it. The three cops come out of the Barrel and seeing some guy crawling around on the ground by locked cars think that the guy was trying to break into cars. Both sides claim they identified themselves as cops and both sides claim the other side didn't. Eventually the guns come out. A total of ten shots were fired. The rookie was hit above the knee. Bob was hit by a piece of flying concrete from a ricochet. The other eight rounds went elsewhere. I was the first uniformed officer there. The call started as a "fight call" and then escalated to "shots fired." When I arrived on the scene and notified dispatch, in the background you could hear shots being fired. As I get to the corner, the military policeman fires one warning shot into the air. We didn't know who the players were. We had no idea it was cops vs. cops. I started down the street from 4th and I saw the rookie that had been shot. I told him to get to the ground. He goes down, so far so good. Then he rolls over, brings his hands into his chest and then into his waistband area. At that point I am starting to put the old squeeze on the gun trigger. I started squeezing and then he pulled his hands away from his waistband, took them down and then said, "You mother-fucker, can't you see that I have been shot?" So, I'm at the scene when Sgt. Smith shows up. The thing that stands out in my mind first is that when he came up to me and said he needed an interview. I said, OK and then before he asks me any questions he puts a tape recorder in front of me. In my experience we tape record a hostile witness, we tape record somebody we think is going to lie to you. That's the first thing that goes off in me is, "I'm the fucking suspect here."
II. Establishing a mutual understanding about the incident: Q: As you think back on the incident, what aspects of this event affected you the most?
A: It was being out in a position that was so far out of what I was accustomed to. Normally, the cops would ride in, have some impact on the situation and in some way make the situation better. Someone will go to jail, or pack their stuff and leave. Someone does something at our direction to make things better and this wasn't going to go that way. It was outside of the whole realm of who was the good guys and who was the bad guys. Here I was in a position of testifying at hearings as a witness for agencies who are trying to fire these guys. Eventually, the person I thought was the most at fault got off free.
Q: What message or belief did you receive about yourself as a result of your involvement in this incident?
A: I would say it was a feeling of being inadequate. That I wasn't a good enough cop.
Q: How did you come to believe this feeling of inadequacy?
A: Well, following along what I said a few minutes ago about being able to impact situations and resolve things. Here's one where that wasn't going to happen. There was just no way. Thinking about the thousands of calls we go to that have so many thing in common and even when we are going to one that's a little different there are still some basic things. Somebody grabs the crook, somebody grabs the victim, somebody grabs the witnesses, somebody has the paper and you leave.
Q: If you accepted this belief of inadequacy as true, what effect would it have on your life?
A: Well I did believe at that time. It had .. I got very discouraged abut my job. My sleep went down, my productivity went down. I was still reacting to the 4th Street Bar shooting. That was all before I started drinking. God knows what role that would have played. I started drinking a little over a year later.
III. Finding alternative possibilities to the story. Q: Can you think of a time when you were at your very best as a police officer?
A: The standout one for me was the fellow at 212 Maple who was holding a rifle to his head. I talked to him at the door for an hour and 55 minutes.
Q: What makes that a time when you feel you were at your very best?
A: This was a tough one. When I first talked with him - he couldn't see me- and he would say things like, "Are you up or down? I want you down." I asked him why and he said, "Because I like you and when I shoot myself I don't want the bullet to go through me and into you." It was just an hour and 55 minutes of talking to him and talking him out of committing suicide.
Q: If you were to watch a film of the first incident, the shooting incident, but your twin brother was involved, how do you think you would have interpreted or judged his actions?
A: (Long pause.) I will give him an 8 out of 10.
Q: That's pretty high marks.
A: Yeah, I think the only place for |