24 - Can debriefing work? Critical appraisal of theories of interventions and outcomes, with directions for future research

Summary

EDITORIAL COMMENTS

This chapter draws together historical, social and psychotherapeutic strands as they contribute to the background of debriefing and its evolution. Its relation to military psychiatry, crisis intervention, narrative tradition, psychoeducation, grief counselling, group psychotherapy, behavioural and cognitive therapies, and psychopharmacology are touched upon and their implications for an ‘eclectic model’ considered.

McFarlane provides a framework for synthesis but one where the reader will be called upon to expand and explore underlying detail. Possible theoretical bases for the effects of debriefing, either positive or negative, are explored. Of particular interest is the view that the acute response period may be more amenable to pharmacological than to psychological interventions.

The lack of good outcome data on debriefing, both through the difficulties of researching this type of intervention or indeed ensuring its fidelity, lead to the important emphasis on the need for further research. As McFarlane suggests, this may require a previously developed set of instruments, an on-line funding source and an international consortium to answer the questions that must be addressed about the effects of this type of intervention. This is the more so with the recent Cochrane Review, as well as other studies that indicate few findings of benefit and some concern over potential for negative outcomes. Furthermore, financial, legal and occupational health and safety requirements may place demands for the provision of debriefing with the belief that it will lessen costs and workforce damage.