CISM

[Chaplaindon]

"The powerpoint that is critical of CISM has some good, and important information.  The most important is (and I'm paraphrasing the critique), CISM should never promise results that the process cannot deliver.  I get nervous when I hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD.  I also get nervous when institutions require their workers to participate in a CISM debriefing.  A debriefing will be beneficial for some, not for all, and those that are their against their will could actually be harmed."

Chaplain Boldin, I suspect some of the criticisms, such as you mention, can be based upon semantical subtleties taken in different ways. What I mean by that is that (for example) when you speak of the assertion that you "hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD" that CAN be true ... the use of the word can means that "it MAY" (in certain cases) and/or "it HAS" in cases, done so.

Such is a fair and completely true way of using the word. Sadly, it can (note my usage here) likewise be taken to proffer some sort of promise of success.

Can a CISM intervention prevent symptoms (note I said "symptoms," not the condition) of PTSD ... I would say certainly it CAN. Does it always prevent such symptoms ... NO.

Also, stating that an intervention can "prevent the symptoms of PTSD" is far different than asserting that CISM can prevent PTSD. I am unaware of any ICISF literature that asserts such a silly idea. It's certainly NOT in any of the courses I've taken.

With that being said, however, one needs to realize that many of the symptoms (a feeling, sensation or physical manifestation that someone tells you they are experiencing) of a CIS reaction CAN (note my usage again) ALSO be symptoms of PTSD.

Normally the "differential diagnosis" (between PTSD and CIS reaction) is determined, NOT by the symptoms themselves, but by their duration (usually persisting more than 30 days).

For example, nausea and vomiting, loss of appetite, sleeplessness, nightmares, inability to concentrate, loss of faith, and so forth CAN BE symptoms of BOTH CIS reactions (which can be, at least normalized in many cases, by CISM interventions) and PTSD. Actually, I suspect these could be symptoms of many diverse conditions including clinical depression.

The fact, also, that these symptoms (and related "signs" e.g. dissociative behavior, etc.) can be produced by a variety of conditions from the minor to the dangerous, is another reason for the presence of the MHP. They can help assess, at a professional level, and ensure a referral if needed, and hopefully the best possible outcome for all.

It's a bit like my former career in EMS. The symptom of "chest pain" can describe many possible conditions. Can it be a symptom of a heart attack ... you bet. Can/could it be a symptom of something else (absolutely too) ... a physician in a hospital is the best person to make the differential diagnosis.

Like EMS, CISM is a "first aid" provider. We leave the definitive care to those qualified and equipped for it.

Is CISM the "one shot" CURE for CIS and/or PTSD? Absolutely not. Can CISM help many people deal with issues related to CIS? I believe it can.

In other words, it MAY be helpful, but not always.

[DogCollar]

Chaplain Boldin, I suspect some of the criticisms, such as you mention, can be based upon semantical subtleties taken in different ways. What I mean by that is that (for example) when you speak of the assertion that you "hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD" that CAN be true ... the use of the word can means that "it MAY" (in certain cases) and/or "it HAS" in cases, done so.

Like EMS, CISM is a "first aid" provider. We leave the definitive care to those qualified and equipped for it.

Is CISM the "one shot" CURE for CIS and/or PTSD? Absolutely not. Can CISM help many people deal with issues related to CIS? I believe it can.

In other words, it MAY be helpful, but not always.

Chaplain Don,

I find that you and I are in complete agreement.  In my work as a hospital chaplain I have come to appreciate that symptomology can produce a myriad of diagnoses!  It takes training, an experienced "eye," and a level of trust in the relationship to come up with "the" correct diagnosis.

It is my hope that all of us who believe stongly in CISM, as I do and I know you do, will listen to the critiques that are out there.  The main critique I would have is to recognize that the "model" has a lot of built in flexibility.  The debriefing model will not work in some situations.  I find that the literature is now suggesting that a debriefing should be offered only when other options have not been effective.   This makes a lot of sense to me. 

I hope that you are well?  I appreciate all that you do.

[Chaplaindon]

Ch. Boldin,

Thanks so much. Your work and devotion to CAP CISM is a blessing.

Ch. Don

[ltcoltsayler]

We don't just need directors.  That's great if someone can get to that status, then provide the opportunity at Wing level.
It's the "peer" thing we need to think about as well, as a director or chaplain may not always be a peer.  They can help, but not as much as a peer.
I took the course (paid by my employer - gave them the benefit of sending me in case something happened at work) from the State CISM conference being held near me.  It can run a few hundred $$.
So, I applaud those that are volunteering thier time to teach others, from National on down.
The most significant impact of taking the course at a joint First Responder conference is realizing exactly how important peer CISM folks are.  More trust, better results.