What are some common challenges and pitfalls in critical incident stress management?

1 Ethical dilemmas

CISM involves sensitive and complex situations that may pose ethical dilemmas for the practitioners. For example, how to balance confidentiality and duty of care, how to respect cultural and religious diversity, how to avoid imposing values or beliefs, and how to deal with potential conflicts of interest. To address these dilemmas, CISM practitioners need to follow ethical guidelines and principles, such as informed consent, beneficence, non-maleficence, autonomy, and justice. They also need to seek supervision, consultation, and peer support when in doubt.

2 Vicarious trauma

CISM practitioners are exposed to the stories and emotions of people who have experienced trauma, which can affect their own well-being. This is called vicarious trauma, and it can manifest as symptoms of post-traumatic stress disorder (PTSD), such as intrusive thoughts, nightmares, avoidance, hyperarousal, and emotional numbing. Vicarious trauma can impair the practitioner's ability to provide effective and compassionate CISM, and can lead to burnout, compassion fatigue, or secondary traumatic stress. To prevent or cope with vicarious trauma, CISM practitioners need to practice self-care, such as setting boundaries, managing stress, seeking social support, engaging in hobbies, and seeking professional help if needed.

3 Resistance and stigma

CISM recipients may not always be willing or able to participate in CISM interventions, such as debriefing, defusing, or counseling. This can be due to various factors, such as fear of being judged, lack of trust, denial of distress, preference for coping alone, or cultural norms. Resistance and stigma can hinder the effectiveness and accessibility of CISM, and can increase the risk of adverse outcomes, such as chronic stress, depression, anxiety, or suicide. To overcome resistance and stigma, CISM practitioners need to build rapport, respect individual differences, provide education, offer choices, and collaborate with other stakeholders.

4 Unrealistic expectations

CISM is not a magic bullet that can erase the impact of trauma or guarantee recovery. CISM is a short-term and supportive intervention that aims to mitigate acute stress reactions, facilitate normal coping processes, and identify and refer those who need further assistance. However, some CISM recipients or practitioners may have unrealistic expectations of what CISM can do, such as expecting immediate relief, complete resolution, or permanent protection. Unrealistic expectations can lead to disappointment, frustration, or false sense of security. To avoid unrealistic expectations, CISM practitioners need to clarify the goals, limitations, and outcomes of CISM, and to monitor and evaluate its effectiveness.