Critical Incident: What Happens After?

[David Baxter PhD]

Critical Incident - What Happens After?
Counselling Connection
October 14, 2010

When we experience a threatening event, our bodies automatically respond in a way that allows us to protect ourselves or escape from the situation. This fight or flight involves an increase in heart rate, blood pressure, muscle tension, and breathing rate. All these changes help us to physically deal with danger or leave the situation very quickly if necessary.

During a critical or traumatic incident with a client this reaction will be very strong, especially if it is the first occurrence and experience the mental health professional has had in working with a challenging client.


The common reactions experienced may include:

1. shock disbelief numbness intense fear
2. anger confusion pounding heart trembling or shaking
3. sweating excitement nausea fast breathing

It is normal for mental health professionals to continue to experience a number of invasive thoughts, feelings, and behaviours for a number of days or even weeks after the traumatic event. These reactions can be distressing and are a sign that you are recovering from severe stress. Some prolonged emotions that a professional may experience after experiencing a traumatic response to a challenging clients reactions or situation include:


Fear:

1. Of a recurrence
2. For the safety of one?s family
3. Seemingly unrelated fears
4. Being easily startled

Anger:

1. At what happened and the senselessness of it all
2. At who ?caused it to happen?
3. General irritability

Shame:

1. For having appeared helpless
2. For not behaving as you would have liked
3. For being better off than others

Sadness:

1. About the losses
2. About the feelings of safety and security
3. Feeling depressed for no reason

Sleep disturbances:

1. Difficulty getting to sleep because of intrusive thoughts
2. Restlessness, awake often during the night
3. Dreams and nightmares about what happened
4. Feeling tired all the time

Memories

1. Flashbacks: ?reliving? the event
2. Thoughts of other frightening events
3. Preoccupation with and frequent thoughts of the event

Confusion:

1. Difficulty making simple decisions
2. Not concentrating

Physical:

1. Muscle tension, trembling or shaking, headaches,
2. Diarrhoea or constipation, sweating, nausea.

Social:

1. Withdrawal from others and a need to be alone
2. Easily irritated by other people
3. Feeling of detachment
4. Avoiding any situation that may remind you of the event
5. Loss of interest in normal activities
6. Not wanting to go to work

Habits:

1. Increased use of alcohol, cigarettes or other drugs
2. Loss of appetite or increased eating
3. Loss of interest in enjoyable activities
4. Loss of sexual interest

Relationships:

1. Sometimes strains and tensions can appear with workmates, partners, family and friends.
2. You may find it challenging to talk about what you have been through
3. You may not want to burden others with your problems
4. You may not think they are as understanding as you would like them to be
5. Changes in your behaviour may worry or annoy them

What to do immediately after a traumatic client event

1. Make sure you are with people. Do not go home to an empty house.
2. Talk about the incident withe others. Talking will help you get over the reaction.
3. Remind yourself that the event is over and that you are now safe.
4. If possible get some physical exercise. This will help ?burn off? the adrenalin.
5. Don?t over use alcohol or other drugs.
6. Try to eat something, even if you don?t feel like it.
7. If you can?t sleep, get up and do something until you feel tired.

How to Handle the Next Few Days

1. Don?t be hard on yourself. Remember your reactions are a normal result of trauma and will pass in time.
2. Try to get back into your normal routine as soon as possible.
3. If you feel scared, or anxious, take some long, slow breaths and remind yourself that you are safe.
4. Be kind to yourself, you deserve it.
5. Try to accept support from others, even if you feel a bit distant.
6. Give yourself permission to feel ?rotten? for a while.
7. Accidents are more common after severe stress so take care.
8. Try to get adequate sleep, a good diet and regular exercise.
9. Practice relaxation to reduce nervous tension.
10. Allow yourself time to deal with the memories. Some may be challenging to forget.