Defining Debriefing is an Arduous Task

The concept of debriefing is hard to define as it has come from an old military term which required the systematic recalling of events to extract new information (Fanning & Gaba, 2015), which could be argued more for the facilitator/debriefor rather than the debriefee. Kaplan (2001) however argued that debriefing in WW2 military setting was also instrumental in improving performance and cohesiveness amongst the group, which provides context that the concept of debriefing has never been a fully agreed upon definition. Therefore, it is reasonable to suggest that there may be more than one way to debrief that involves interactive, bidirectional, and reflective discussion or conversation that filters through a process of facilitation and guidance (Sawyer et al, 2016). However, it is important to remember that both the facilitator/debriefor and the debriefee will bring complex human experience equally to the debriefing moment as Dismukes, R.K; Gaba, D.M. & Howard, S.K. (2006) suggested:

“When it comes to reflecting on complex decisions and behaviors of professionals, complete with confrontation of ego, professional identity, judgment, motion, and culture, there will be no substitute for skilled human beings facilitating an in-depth conversation by their equally human peers.”

Recent Research on Debriefing

Fanning & Gaba also acknowledged that the debriefor’s presence may impact the process (2015, p66).

”Of course, not all post event debriefings are the same. How they are conducted, and by whom, can have a significant effect on both the learning process and the learning climate.”

Fanning & Gaba (2015) further added that the debriefing skill may be the most challenging skill to perfect.

Rippon et al (2020) conducted a grounded theory analysis on frontline staff from health and care field experiencing stress, who experience behaviours that concern from the service users they work with.

They found 5 categories, one of which organisational identified a request for mandatory post-incident debriefing for employees.

They also found that failure to provide post-incident debriefing were essentially missed opportunities to:

1. Support reflective practice amongst staff
2. Problem solve as a way to prevent behavioural symptoms of service users
3. Offset unhelpful rumination on incidents of behaviour that challenge
4. Offset work related stress that arose from experiencing behaviours of concern amongst the service users

Rippon et al (2020) further acknowledged that consideration was required to how the debriefing was carried out since the staff could be traumatised, and there was a need to not re-traumatise those individuals. Therefore, emotional and instrumental support should be built into the debriefing model.

This concept of emotional containment/ debriefing is rooted within the concept of Neurotransception (Doyle 2017; 2021; 2023), which in essence neutralises distress so that staff can realign themselves within the dynamic with the service user in ways that promotes healthy engaging relationships as opposed to distressed and fractured.

Relational Dynamics within a Debriefing Protocol

Although the debriefing model may use reflection on action in the process of continuous learning (Schon, 1991) the debriefing model itself is a continuous reflection, in which it is also continuously evolving and should do so by considering the bi-directional relationships between those that are engaged within the process about those who were part of the event.

Therefore, it may be more adaptive to view debriefing through the lens of relational dynamics that exist between different applications of the debriefing method that range from functional to communicative to emotional exploration that are co-constructed between debriefor and debriefee regarding service users, as equal partners to bring new meaning and learning that positions potential new ways of interacting in the future.

I explained this from my doctoral research excerpt Doyle (2023).

“There was an integration between Schon’s (1991, p.276) reflecting ‘in action’ and ‘on action’ , where I reflected ‘in action’ by reflecting back on what the participant had said in the past. I reflected ‘on action’ when I embodied the action of the verb as I currently related to it. As Bryant (2017, p.275) stated, reflecting ‘in action’ opens up the possibilities of seeing things in a new light, casting off the habits and assumptions that usually sustain our actions. If this is followed later on by reflecting on these new possibilities, it may result in fresh insights and ideas that can be tested more rigorously.”

Debriefing therefore may require a more expansive way to explore this way of making meaning. This is also why Neurotransception and the concept of spaciousness is applied to create space that allows for all competing and divergent agendas that can occur across the relational dynamics between the service user, the staff member who is in need of debriefing, and the organisation that provides the service.

Applying Principles of Neurotransception within a Debriefing Protocol

Neurotransception (Doyle, 2017; 2021; 2023) is based on the principle of transmission and receiving of each other at an embodied neurobiological level seeking safety (Porgas, 2004).

When divergent intersubjectivities from different neurotypes meet, imposed power dynamics from conscious/unconscious levels may evolve based on the non-autistic other’s intrasubjective misinterpretations to reconfigure their prediction error in predictive coding theory (Friston & Kiebel, 2009). This may manifest as an attempt to fix rather than relate to an individual, resulting in exacerbated experiences of masking, shaming, as well as trauma and attachment based reactive responses.

Spaciousness within the Debriefing Protocol

We also need to understand how to develop a space that allows debriefing to take place. Spaciousness meant self and other feeling safe as fellow human beings where one had not a conscious/unconscious monopoly over the other in the relationship between therapist and client. Spaciousness involved expanding the gap of inclusivity without creating spaces for polarising, where one Neuro-type was not explored in a vacuum. It meant understanding relational dynamics occurring within Neurotransception and knowing the difference between intra-subjective and intersubjective spaces within that spaciousness.

Spaciousness supports one’s allostasis and homeostasis balance so that the individual is not under an overwhelming allostatic load. This meant resisting the urge to apply a strategy/intervention to access an imposed goal. Instead, this meant being very present in the moment, and mutually uncovering a space where the individual could direct the trajectory of atherapeutic process from a more balanced space as opposed to a reactive one. This spaciousness was purposeful within an intersubjective rather than an intra-subjective, ego-imposed interpretation.

Spaciousness integrating with intersubjectivity and regulation meant there could be a certain amount of chaos attached to this space and that the staff member may need to be aware when not to interrupt. Therefore, learning how to know the difference between regulating and being in a reactive position of distress was something that could be useful to explore.

References

Fanning RM, Gaba DM. Debriefing (2015). In: Gaba DM, Fish KJ, Howard SK, Burden AR, eds. Crisis Management in Anesthesiology. 2nd ed. Philadelphia, PA: Elsevier Saunders.

Kaplan Z, Iancu I, Bodner E. A review of psychological debriefing after extreme stress.

Psychiatr Serv. 2001;52(6):824–7.

Sawyer, T., Eppich, W., Brett-Fleegler, M., Grant, V., & Cheng, A. (2016). More Than One

Way to Debrief: A Critical Review of Healthcare Simulation Debriefing

Methods. Simulation in healthcare : journal of the Society for Simulation in

Healthcare, 11(3), 209–217. https://doi.org/10.1097/SIH.0000000000000148.

Dismukes, R.K; Gaba, D.M. & Howard, S.K. (2006) So Many Roads: Facilitated Debriefing in Healthcare. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 1(1):p 23-25.

Rippon, D., McDonnell, A., Smith, M., McCreadie, M., & Wetherell, M. (2020). A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge. PloS one, 15(2), e0229706. https://doi.org/10.1371/journal.pone.0229706.

Doyle, R. (2017). Bridging the gap, between the autistic, the therapist, and the theoretical perspective: an intersubjective awareness. 23rd Annual BACP Research Conference, Chester.

Doyle, R. (2021). Neurotransception: Negotiating the intersubjective space between us, away of being in research 25th Annual BACP Research Conference, online.

Doyle, R. (2023) Bridging the gap between the autistic individual, the therapist, and the theoretical perspective: an intersubjective analysis. Middlesex University.

Porgas, S. W. (2004). Neuroception: A subconscious system for detecting threats and safety. Zero to Three, 24(5), 19–24.

Schon, D. A. (1991). The reflective practitioner: How professionals think in action. Aldershot: Ashgate Publishing Ltd.

Friston, K., & Kiebel, S. (2009). Predictive coding under the free-energy principle. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 364(1521), 1211–1221. https://doi.org/10.1098/rstb.2008.0300