Crisis response heals the invisible wounds of trauma

Crises ranging in severity from bank robberies to national tragedies such as the Boston Marathon bombings are the province of a new breed of healers such as Crisis Care Network.

The network responds to some of our worst nightmares and continues working with clients in Boston and throughout the country, offering psychological support to crisis.

Critical incident response training was even the focus of a workshop at the American Psychological Association’s recent Work & Well-Being conference in Chicago. This was the first time APA offered such a workshop.

“If you have to step outside (during the session) that would be a reason to question if you want to be involved in this, ok?” said VandePol. “Because this is hard, hard work and it deals with the worst days of peoples’ lives. We’re not talking about treating butterfly phobias here.”

More than ‘butterfly phobias’

Bob VandePol, who led the training session, starting with a personal story of how he was first introduced to crisis intervention.

“If you have been involved or have not been involved, I am guessing that the vast majority of folks who went out for the first time went out white knuckling it. Guilty as charged. I was in a directorship position for a psychiatric hospital. A furniture manufacturing company straight down the road had an awful incident. A young man on the last day of his life was driving a forklift and tumbled down a loading dock, was pinned underneath it.

“Over 1,000 employees watched for 45 minutes while they tried to extricate him and he died. The very, very professional vice president of HR screamed into the telephone, ‘Send shrinks! Send shrinks! Send shrinks!’ And so we loaded up a couple vans full of shrinks and went down and did some compassionate loitering for a couple of days and they were immensely grateful and talked about how much it helped and we thought, hmmm, maybe we should know what we’re doing next time. And it seems that, as I’ve trained people on critical response, that seems how most people have gotten involved.”

Evolution of crisis intervention

After 9/11, the controversy still brewed as to whether immediate psychological intervention was helpful or not. Research since shows that psychological first aid provides preferable results than waiting 30 days or later to respond.
This approach is particularly effective in certain circumstances such as the fast-paced environment of a bank.

“Banks require us to be there within two hours. Why? Is there a clinical rational for that? Heck no. What do banks have to do? They have to re-open quickly. Because they have customers that need that money to keep flowing. So it’s more of a business and more of a corporate culture expectation that you’re there. Banks train their people:  if a robber comes in, smile, give them excellent customer service, give them the money and get them out of the building as fast as possible. It’s insured,’” VandePol said. “People are worth more than the few thousand they’re going to walk out of here with. And, if you’re looking at it from a CFO’s perspective that robbery is a heck of a lot cheaper than a disability claim or a lawsuit or worker’s comp claim. Sorry it’s cold, but it’s the truth.”

VandePol detailed an offbeat bank robbery that Crisis Care responded to.
“A robber walked into a Wells Fargo, grabbed a deposit slip and wrote on it “Give me the money,” but there was a long line. He was an impatient robber, so he went across the street to the Bank of America, which he saw was empty. He walked in, put the deposit slip on the counter. The teller looked at it and realized he had misspelled most of the words, and thought this guy isn’t the brightest bulb in the box. The teller said, ‘I’m sorry, sir, you can’t rob the Bank of America with a Wells Fargo deposit slip, you’ll have to go across the street.’

“And he did. She then dialed 911 but the police didn’t get there right away. There was a violent situation on the other side. Police did catch the bad guy and nobody was seriously hurt, but you might imagine the people at Wells Fargo weren’t real pleased with Bank of America for sending a robber to them. The teller was fired. And it was very divisive for the staff because half of them thought it was the funniest thing they’d ever witnessed in their life. And the other half said, ‘What if he had gotten ticked? You put us in danger.’”

And what does being put in danger feel like, one might ask?

Inside the brain
“When a threat presents itself, our brains and bodies start to work differently. Our body decides, it’s probably not important for blood flow to go all the way to the fingertips – being able to play a piano concerto is not that important right now,” VandePol said. “Oh, that’s why your fingers get cold when you’re nervous.
“Your brain functions differently. There’s a very predictable set of reactions that happen. The part of your brain that makes all of you so very, very good at your jobs is found right behind your forehead…your frontal cortex. Abstract thinking, advanced thought, multi-tasking, being able to take in multiple sources of information and make one good decision. Your parietal lobe, your ability to do math…for most people, your frontal lobe disengages a little bit.

“There are little electricians running around in your head connecting and disconnecting wires to help you for fight, flight, freeze. They disconnect some from there. Behind that is the hippocampus, which is sort of, like a marriage counselor between what you think and what you feel. For most people if the needle were between think and feel under the influence of traumatic stress…bingo. It goes to feel.
“People tend to make rash, emotion-driven decisions without thinking. We’re likely to do that. There can be survival value in that in certain context. There’s now a neuro-superhighway that goes to your amygdala and limbic system, which is all the basic primal defenses and stuff, you do reflexively without even thinking. Neuro-pathway to optical and audio is on hyper vigilant status, people see motion more than they did before, noises sound louder, touch is more pronounced. Taste pretty much disconnects. A great meal tastes like cardboard immediately after this. Digestion becomes more than an adventure. Appetite is diminished and sleep is diminished.”

The importance of resilience 

VandePol emphasized that setting in place firmly the expectation of recovery is important. If people don’t think they will recover from a traumatic experience, that’s what they get.

“I’ll go out to the same robbery and there will be one person curled up in fetal position under a desk, two people crying, one giggling, one yelling at everybody, one with a million mile stare, and one going…are we about done, I want to go to the mall,” VandePol said.
The impact – not the incident – is what’s important to one’s response and recovery.

“You tend to find what you look for. If you walk in there and say, ‘Oh you poor dears you’re never going to be the same again, that’s what you’re going to find and that’s what you’re going to produce,” VandePol said. “If you go in acknowledging the disaster and the impact but you expect most people to do well and to bounce back but are alert to those that may need additional services, then I think you have done your job.”

Those attending the training looked for ways to apply what they learned to their own unique positions.
Jan Stanley, of Positive Psychology News Daily, works for a master resilience-training program in the Army in association with Penn University.

“I think what is different about it is that I think the Army is treating this as more programmatic – it’s not that there’s been one critical incident that has occurred- it’s more the accumulated effects of these multiple deployments and things that have happened over time and it’s creating all new modalities of creating the content,” Stanley said.

Cara Chill, a student intern at the Awakening Center in Chicago – a center dedicated to helping those with eating disorders – said she could see a parallel with her clients to those involved in critical incidents.
“It really resonated with me what he said about going in there expecting resilience, expecting people to rise from it instead of treating people like the victims because whenever I talk to the clients at my internship we always make it a point to say that they’re survivors of abuse rather than victims of abuse so I think the wording is very important,” Chill said. “It really makes you see it through the lens of the person you’re trying to help rather than going in there with your own preconceived ideas. This is their worst day so how are you going to help them?”