Written by: Deborah Mitnick, LCSW-C

I recently conducted a Critical Incident Stress Debriefing (CISD) for an organization that experienced the death of an employee. All details have been altered to preserve confidentiality.

The formal session was 90 minutes and I ran it as a formal session, but would definitely have integrated the session with Emotional Freedom Techniques (EFT) if the need had been strong. Here's how I assessed the need/lack of need for it:

There were 35 people in the room. I introduced myself and set the ground rules for the session. I described the structure of the seven-step CISD process and told them that if, at any time, they developed any emotional intensity, I could provide a very quick relaxation exercise (this is how I would have described EFT at this point) that would probably diminish the intensity. I asked for a Subjective Unit of Distress (SUDS) rating. On a scale of 0 to 10, with 10 being the most intense, there were three people at an 8-9, most at 5-6, and a few at 3-4. Most people were crying or expressing anger, and many were looking tense.

There was one woman who was quietly weeping (Weeping Woman [WW]). The president of the organization had described her to me before the session and she was certainly easy to pick out. The President said WW had been crying for 24 hours. WW never established eye contact with me and I didn't think it was appropriate to call any attention to her at this time.

The group quickly opened up to respond to my "Fact-Phase" questions. SUDS after this phase were reduced for all (who admitted their levels) but two people. WW was now quietly hiccuping, but no longer crying. During the "Thought-Phase" there was a lot of laughter and gallows humor (to be expected in such a session). The group felt comfortable with each other and with me. WW now was watching me carefully when I asked SUDS level. Most folks continued to report lowered levels. They were anxious to move on to "Reaction-Phase." One person (Stoic Lady [SL]) admitted an intensity of 8, but insisted that she was "ok." I asked if it would be ok with her to be less intense and she said, "I'm used to feeling like this. I'm ok." I did a little teaching here with light humor and she said that she'd "probably" want to stay to "try your relaxation thing" after the formal session.

During the Reaction-Phase, SL expressed a lot of anger and sense of responsibility and guilt for not "seeing" and "preventing" the problem that led to the death. Many people still expressed guilt and anger, but the group began to talk more objectively about the deceased. The deceased was no longer being idealized. Instead, the group noticed that she had "been hiding" the problem that led to the death. They began to put the responsibility for her life back on her and there was a "group sigh" that was actually audible. SUDS level was even lower now. WW was nodding her head to the responses of others. SL said her level dropped to a 5.

In the "Symptom-Phase," they discussed numbness, lack of concentration, and many expressed worries that they thought they were hearing her voice, smelling her grape chewing gum, and imagining she was there. They discussed their headaches, nausea, backaches, etc. They asked questions about if they were "processing" correctly and one person wondered if she was "doing it right" because she hadn't yet cried. SL said she could barely grieve about this loss because she'd had so many losses this year and couldn't concentrate on this one. Her SUDS was now a 6. The group lovingly told her they'd like her to work with me and others volunteered to join her in that after the formal session.

In the "Teaching Phase," I told them that I'd give a session of emotional relaxation after the formal session, but if they couldn't stay for that, I described a breathing exercise that they could do at home. I also suggested another relaxation exercise of noticing the tension, for example, in their hands, then exaggerating it to make them more tense, and then releasing it. They tried that and liked it. I anticipated with them that they may experience guilt or "missing her" or loneliness or sense of aloneness and some admitted that they already had that. (I offered to work with those issues using EFT after the formal session, but no one approached me about that afterwards.) SUDS were very low here for most people. Participants were now slouching in their chairs with their hands behind their heads or had their arms slung over the backs of their chairs. No one was sitting forward and clenching hands or jaws now.

During the "Re-entry Phase" people began to plan tributes to the deceased and a few eulogized her. They talked about planning to attend the funeral. They complimented each other on their professionalism with the population they serve and with each other during a very stressful time. They thanked the president of the program for providing them with the CISD opportunity. When I asked them what they found most/least valuable from our meeting, everyone who spoke said that the session helped clarify issues, helped everyone express emotions, provided a safe space, and allowed healing to take place. SUDS was lower than at the beginning for everyone (who admitted it) in the room. SL said she was a 5, "but I'm ok with that." WW was looking intently at me. I thanked them for their participation and shared with them my experience of working with their group. I told them that I was honored that they let me share this time with them; and that I admired how they worked together and how committed they appeared to be to their jobs and to the population they serve. I said (and sincerely meant it) that I felt emotionally enhanced by being with them.

During the "Refreshment-Phase," many people came up to tell me their life-stories. The President asked me to show her the relaxation technique and wanted to work on her fatigue, which she associated with sadness. Her SUDS 3 went to 0. SL told me that she couldn't grieve this current death because her grandmother was murdered recently and that's all she could think about. SUDS: 9. She and three friends went through two rounds of tapping and then she was at a 3. She wanted to stop there, but she spent 10 minutes asking me questions about how the method worked.

WW disappeared the minute the formal meeting was over. The President went to retrieve her. I later found WW standing in the middle of the room, looking at nothing. I went over to her; she sort-of smiled. I asked what her job was at this place and how long she worked there. She attempted to smile as she answered my small talk. I then asked, "How's it going now?" and she burst into tears. I offered to work with her and she accepted.

We went to a private room and for 40 minutes, we worked together with EFT. For each initial round, she was too upset to say the Psychological Reversal (PR) affirmation or tap the EFT tapping points herself. She gave me permission to do it all for her. I consistently did the tapping for her, but she was always able to say the second and subsequent rounds of PR affirmations for each aspect. PR was not always present. I used the short-cut sequence, the full sequence, and the head, ankles, and wrist points, when I thought one of those sequences was indicated. Sometimes I only tapped one or two points and the results were just fine. I was also able to trust my intuition to assess accurately what her SUDS was each time. She only needed 2-3 rounds for most of the aspects.

Here's my assessment of our 40-minute session: When I was doing traditional psychotherapy, this amount of material would probably have taken about 18 months to address. (Notice that I didn't say "resolve.") In this brief EFT session, she handled in this order: "all this emotion, this death emotion, this [deceased's name] feeling, hearing about her death, guilt, responsibility, missing her, anger, losing a good friend, thinking I could have changed the outcome, why did she do that, feeling lost and lonely, and what a way to die." She said that the issues were resolved for her.

I tested each statement at the end by having her repeat statements, such as "I'm responsible for her death." No increases of SUDS for any statements like that. Smiles. Sighs. Relief expressed.

I educated her about the possibility of other aspects emerging and she asked to see me the next day for a follow-up session. The President agreed and contracted with me to come back to work with WW and with others if they needed it.

CISD and EFT: I think that EFT is a fine adjunct to a CISD session. If there is a next-time need for CISD anywhere, I'll be bolder about introducing EFT during the formal session. I think that the talking they did during this session was necessary and they would have felt cheated if the session had been shortened by EFT. (This is my shortest CISD session ever!) Yet I don't think that all of the emotional pain I witnessed was absolutely necessary to have while they were going through the CISD stages. (I remember in my traditional-therapy days believing that pain was necessary in order for therapy to really work. I probably encouraged people to feel pain.)

I think asking for the SUDS rating is a wonderful tool. I was much better able to stay in touch with the emotion in the room this way. My asking also seemed to endear me to the group. They seemed to think it was "cute" that I took care of them this way. This specific group "believed" that they had to suffer a little bit in a CISD session because that's what they were taught and what they expected. It would have been inappropriate for me to violate those beliefs by introducing EFT before the group could have enough of its suffering. I always try to build rapport with a group and I'm usually successful. I think I was successful today.

I called WW at work the next day. She reported that she had felt fine all evening and had slept well. When she got to work she was a 4 with stomachache and tension. After four minutes of using EFT with her on the phone, using shortcut and PR, her SUDS dropped to a 0. She wanted to work in person in the afternoon.

I met with WW at her place of work for one hour that day. She was smiling and looking relaxed. Here's what she said: "Talking to you yesterday made me feel better. I can deal with this more now. I haven't cried any more and now I can work. I can talk about it better. I don't get upset about it. I slept better. Her dying is not my fault. Yesterday I thought I could do something for her, but I now know that I did everything I could have done. I was there for her and I know she appreciated that. I do feel bad that it had to come to this [her dying], and I wish she could have talked to me, but I feel fine about it now."

I wanted to "test" her so I had her repeat many statements that we had needed to tap for the day before. For example: "I'm responsible for her death." "I should have done more." "I missed the signs." "I could have changed the outcome." "I lost a good friend." "I'm going to miss her." "She's dead."

For each of these statements, she reported a SUDS level of 0. She smiled. She laughed and expressed wonder and amazement that she felt so good and emotionally "uncharged" while making these statements. She said, "I'll miss her and it's sad that she died, but I don't feel upset inside now."

Fifteen minutes of our session had passed. Because she was feeling so good, I wondered if I should leave. But I decided to ask her to anticipate how it would be to go to the funeral a few days later. She agreed to this exercise. I asked her to think about what SUDS rating she would have if I asked her to close her eyes and imagine the funeral scene. That number was 0. I then had her close her eyes and run through the "movie" of the funeral, from the time she started to get dressed for it, driving there, walking up to the casket, looking at the body, seeing the family, hearing the sounds of crying, etc., etc. She still reported a SUDS level of 0.

She then wanted to review previous losses she's suffered. We discussed the deaths of a few of her extremely close relatives, the guilt she felt about what she had or hadn't done in relation to these relatives, the funeral and casket scenes, and her own fears of death that came from those experiences. She did not feel intense about any of these topics. She said, "If you had asked me about these yesterday or any time before that, I would be sobbing now." I said, "Why do you think you're not sobbing?" She said, "This tapping seems to have straightened me out about a lot of things, I guess."

We discussed that if she were to cry at the funeral, that would not be at all abnormal; and it would not be abnormal to feel sad and weepy. I said that the tapping is not meant to take away "normal" responses to events. She said she understood that and said she'd be "ok" at the funeral. Just to be sure, she said she wanted to tap for the following things, and so we did: "All these losses." "[Deceased's] death reminds me of my other losses." "Seeing the casket anxiety."

The hour was up and she was happy and relaxed. She asked me how she could use the tapping on some physical problems and on self-esteem issues she's had and I gave her a little information about that. I invited her to call me for brief phone sessions, if she wanted. She laughed and thanked me and said that her co-workers and husband were amazed at the changes they'd noticed.

So, I said goodbye to Laughing Lady (LL)!

Later that day, the Director of the program called me to tell me how pleased she was in the transformation she noticed of WW to LL! She also said that everyone who had attended the debriefing was doing well and that many had achieved the desired closure from that meeting.

She said, "I got double mileage from having you here. My staff is doing so much better and people have noticed how much this company cares about them to have provided your services."