Psychologi
first
aid
cal
Self-help techniques and compassionate
support following accidents, assaults or
other dramatic experiences
Reactions to be expected
If you have experienced something dramatic, you will often find yourself reacting both physically
and emotionally. Once you know the usual reactions, it is hopefully easier for you to accept and
acknowledge them. It is also a good thing if your colleagues, your family or those closest to you
know about crisis reactions.
Violent incidents are unsettling. Our usual way of solving problems has been proved inadequate,
and our beliefs and assumptions about who we are and possibly also what sort of world we inhabit
have been shattered. This triggers a reaction – and the reactions may be many or few.
This folder aims to provide information on:
o Crises and the stages of crisis development
o Common reactions after violent incidents
o Self-help techniques
o Psychological first aid and compassionate support
o When to seek professional help
o Where and how to get professional help
o General information on crisis help and organisational consultancy
o Literature and useful links
Contents
Reactions to be expected
What is a crisis?
Stages of crisis development
Common reactions in first few hours
Common reactions over subsequent days and weeks
Self-help techniques
Psychological first aid and compassionate support
When to seek professional help
Public counselling services
Danske Krisekorps’ services
Useful links
Page 2
Page 3
Page 3
Page 4
Page 5
Page 6
Page 7
Page 8
Page 8
Page 9
Page 10
About Dansk Krisekorps
Page 11
Appendix:
General information on crisis help and organisational consultancy
General guidelines regarding psychological first aid/emergency help
following accidents and psychological/physical assaults on employees
General advice to the management on establishing crisis contingency plans
Specific suggestions for procedures in connection with emergency crisis situations
Own notes
Page 13
Page 14
Page 15
Page 15
Page 16
2
What is a crisis?
A crisis is a dramatic development characterised by rapidly changing emotions as well as strong,
alien and overwhelming reactions. The events which trigger these reactions can vary enormously,
but they share the following characteristics: They are external events, the person has lost or
experienced the threat of losing something important, and their previous experiences and ways of
tackling problems have been proved inadequate.
A crisis is also characterised by the situation returning to some sort of normal state within the
space of a few months. According to the definition, a crisis is thus a short-term and time-limited
condition. The fact that a crisis is brief does not mean that what has happened has necessarily
been resolved in the victim’s mind. It may have been repressed or shut away, but some sort of
readjustment will always take place. This readjustment can be of a positive kind, with the victim
living through the phases of the crisis and being able to move on as a wiser person. Alternatively,
the readjustment may be negative in nature, with the person suffering an impaired quality of life,
and experiencing physical and psychological symptoms.
Crises
Normally, a crisis can be divided into four phases: the shock phase, the reaction phase, the
resolution phase and the new orientation phase. Even though the process is described in terms of
phases, most people will experience it as a dynamic process of overlapping phases.
Shock phase
The victim is unable to think and act rationally; he or she suffers temporary paralysis. The shock
protects the victim from acting rashly and also against violent emotions. The shock can be
momentary or last up to several days. The victim has the feeling of being in a goldfish bowl, of
seeing events unfold as if he or she was watching a film, as if it wasn’t happening to them.
In this phase, the victim needs to be protected and looked after.
Reaction phase
The victim will try repeatedly to explain what took place to try and make sense of what happened.
Often they will experience feelings of guilt and shame as well as many contradictory feelings;
some will be intense, others barely discernible. The reaction phase can last for weeks, but if the
victim receives the necessary social and psychological support, the reactions will slowly subside.
The victim needs to be listened to and his or her thoughts and feelings acknowledged.
Resolution phase
The victim accepts what has happened, and his or her feelings, reactions and thoughts. The
incident is becoming a historical event which can be discussed rather than something which
causes suffering. The person’s focus can begin to shift to other things in life. This phase can last
from a few weeks to months.
New orientation phase
The victim has integrated what has happened, his or her reactions and often new aspects of
himself or herself. They now feel they have the energy to look ahead, on the basis of the new
experience they have acquired and what they have learned. Often the incident will make the
person more aware of the important things in life.
3
Common reactions in first few hours
Feelings of unreality
What has happened may be experienced as a kind of dream or nightmare – something which is
not real. Many people describe it as being like a film which they are watching. Your sense of time
can change – time either almost stands still or is in fast forward. Certain sensory impressions can
become seared into the consciousness. What happened can seem irrelevant, and you can feel
strangely empty and have the sense of being in a goldfish bowl.
Intense emotional outbursts
In the actual situation, many people experience no emotional reactions. This can be a sign that
they are in a state of shock, which helps to protect them from suffering a nervous breakdown.
Later, you can be overwhelmed by feelings of helplessness and react strongly, for example with
tears, anger, screaming or rage.
Fear
You can be afraid that you are going mad and becoming mentally ill because you are unable to
recognise yourself in the midst of all these intense feelings. Afraid of being deserted, feeling
fearful for the lives of those around you, afraid of never getting over it, or afraid of the violent
incident happening again.
Anxiety
The anxiety is not directed at anything in particular, it can lead to agitation and restlessness and
act as an obstacle to doing anything concrete. By trying to put your feelings of anxiety into words,
they can be turned into fear which is directed at something concrete. It is easier to handle a fear
of something specific than the indefinite feeling of anxiousness.
Physical reactions
The body can react in different ways. The victim may suffer head, chest or tummy pains. You can
feel nauseous and experience vomiting. Your knees can feel weak, or you have the shivers or cold
sweats. You can also be troubled by frequent urination, diarrhoea, heart palpitations or breathing
difficulties.
4
Common reactions in subsequent days and weeks
Involuntary flashbacks
Many people find that during the period following the incident they experience flashbacks,
nightmares or obtrusive memories. These memories are often very graphic and include detailed
images of the experience, prompting strong feelings. Thoughts about the incident or particular
smells or sounds can be enough to trigger the physical reactions again.
Always ‘on guard’
You are easily scared by sounds and smells as well as sensory impressions and you are easily
startled.
Sleeping problems
Problems falling asleep – perhaps you wake up several times during the night or wake up too
early.
Vulnerability and irritability
The physical and mental strain makes the victim feel vulnerable and thin-skinned. It is easy to
misinterpret your surroundings, and you quickly feel let down and misunderstood by others. This
can lead to increasing impatience, irritation and conflicts with other people.
Intense feelings
Intense and often contradictory feelings: anger at the meaninglessness of the experience – “Why
me?”, grief at having lost something valuable; relief at being alive. Perhaps you swing between
feelings of powerlessness and hope.
Guilt and shame
Feelings of guilt and self-recrimination are also common reactions, even in cases where there is no
obvious reason for them. You can feel guilty for not having helped others at the scene of an
accident, or for something which you never managed to say or do. It can be hard to forgive others,
and almost impossible to forgive yourself. It is also possible to feel guilty for having been luckier
than others. A sense of shame can stem from not having been in ‘control’ of the situation, or from
not appreciating its seriousness.
Concentration and memory problems
It may be difficult to concentrate on one thing for a sustained period of time. You easily retreat
into your own world, where the experience is continually in your thoughts. Some people also find
their memory fails them for a time.
Confusion and isolation
You can feel sad and down in the mouth, wanting to cut yourself off from the people around you
to avoid being reminded of what happened.
Meaning to life
Finding a new meaning to life can seem hopeless. Everything is insignificant compared to what
happened. Many people start speculating about how tenuous life actually is. For some, this leads
to a greater awareness of what is important.
5
Self-help techniques
Accept that it is natural to react
Acknowledge all feelings, thoughts and actions, even those you find frightening and strange. It
helps to cry.
Share your thoughts and feelings with others
Show your weaknesses so that people around you don’t believe you are managing all by yourself.
Accept other people’s support and care. If possible, spend time with other people who have had
similar experiences. It is particularly important that you share your experiences with the other
people who were involved in the event and those who are close to you.
Keep telling
– even once it is no longer news. Find someone in whom you can confide. Every time you talk
about how you feel, parts of the difficult experience will be resolved.
Confront reality
– preferably together with someone you know and trust: look at photographs, look at the things
which were damaged or destroyed, visit the places and people you associate with what happened,
return to the scene of the accident, see the deceased if you have lost someone close to you and
attend the funeral.
Allow those around you to react
Let your children and those close to you express their feelings and thoughts – everyone will be
affected by the situation in their own way.
Maintain your daily routines
Resume working as soon as you think you are up to it. Perhaps ask for a special arrangement/‘light
work’ to help you through the hardest period.
Look after yourself
New accidents – also traffic accidents – are more likely to happen after a terrible event.
Get a good night’s sleep
If, initially, you find it hard to fall asleep at night, try drinking a glass of beer or asking your doctor
for light sleep medication.
Don’t turn your back on the problems
When life is difficult, it is tempting to use escapist remedies such as medication, alcohol or hectic
activity. These might relieve the immediate pain, but if they develop into a lifestyle, then new
problems will emerge.
Seek distraction
Every so often, make sure you turn your mind to something else and do something enjoyable.
Physical activity is good as it counteracts stress. It is also okay – and beneficial – to be able to look
forward to things in life, both large and small.
6
Psychological first aid and compassionate support
Be there
Contact the victim and spend time with him or her. Compassion in itself is very healing.
Provide information
Provide relevant information to the victim so he or she can get a sense of perspective of what has
happened. Repeat important information. A victim can find it difficult to remember what he or she
has been told due to a general impairment of their concentration.
Active listening
Keep an open mind and accept the victim’s version of events. Be prepared to listen to accounts of
what happened again and again. Avoid belittling or over-dramatising the victim’s thoughts and
experiences or trying to take his or her mind off the subject. Also, avoid using empty expressions
which are not in any way helpful to the victim.
Ask questions
Ask direct, specific and elaborating questions which help the victim to grasp what has happened.
For example, you might say: Try telling me what happened first. What did you do/think at the
time? Who else was there? Where were you? What happened afterwards? What did you do/think
then? How did you react? How are you now? What are you thinking about now? What is going to
happen now – and later? Do you need help/support?
Avoid asking why
“Why” questions call for “because” answers. It is hard for victims to provide explanations as they
are often very confused about what has happened.
Don’t dismiss feelings of guilt
When feelings of guilt are met with a respectful ear and impartial information, it can have a very
calming effect. On the other hand, being told to be realistic and that there is no point in
speculating about matters beyond your control results in the victim feeling that talking to other
people is a pointless exercise.
Gently insist on making contact
It might well be that the victim does not want to talk about the event. If you are turned away, you
can always say that talking about what happened is beneficial. If the person still doesn’t want to
talk, try again later.
Offer practical help
Help the victim with practical tasks if required. However, any practical assistance should only be
provided as a way of supporting the person – you should not assume responsibility as it may
compound the victim’s sense of helplessness.
7
When to seek professional help
o
o
o
o
o
o
o
o
o
o
o
If you don’t have anyone to talk to about what has happened
If you are very worried about your condition
If you continue to feel low and unwell
If your family and working lives are being affected more and more negatively
If you are experiencing sexual problems, insomnia or nightmares
If you are continuously troubled by self-reproach and guilt
If you are becoming more and more irritable, irascible and unconcentrated
If you are feeling increasingly indifferent towards yourself and those around you
If you are having to be constantly active to forget about your feelings
If you develop physical symptoms
If you are beginning to drink and take medication every day
The extent of people’s reactions to violent experiences and their duration vary considerably.
Perhaps the reaction is amplified by previously repressed experiences surfacing as a result of the
new and difficult situation. A general sign that professional help is required is if the reactions
endure or intensify.
Your reactions are not a sign of weakness, but if, several weeks after the event, you are finding
that your daily life is a huge burden, then you should seek professional help.
Public counselling services
You can make an appointment with your doctor or your local vicar. Moreover, your doctor is able
– with your permission – to refer you to a psychologist or psychiatrist.
The following victims are eligible for subsidised consultations with a psychologist under the public
health service:
o
o
o
o
o
o
o
o
Victims of robbery, violence and rape
Victims of road traffic accidents and other accidents
Close relations of people with a serious mental illness
Persons suffering from a seriously disabling illness
Close relations of people suffering from a seriously disabling illness
Bereaved family members
People who have tried to commit suicide
Women who, as a result of their unborn child having a congenital deformity etc., have had an
induced abortion after the 12th week of pregnancy
o Persons who, before the age of 18, have been victims of incest or other sexual assault
o Persons aged 18+ years suffering from light to moderate depression
o Persons aged 18-38 years suffering from light to moderate anxiety, including OCD
Referrals to a psychologist cannot usually be issued more than 12 months after the event. If
several people in a single group or family want to see a psychologist, it is possible to organise
consultations for couples or groups. Subsidies are available for a maximum of 12 consultations.
Members of the mutual health insurance company Sygesikringen Danmark are also entitled to
financial subsidies for consultations with a psychologist. Psychiatric treatment is free on referral
from a doctor.
8
Corporate counselling services
If the company where you are employed is a Dansk Krisekorps client, the following crisis help is
available:
o Psychological first aid for the affected employees provided by qualified psychologists (see the
intranet; contact your immediate superior or contact person)
o Psychological crisis support for employees and management in the emergency situation and
guidance on follow-up initiatives
Or, depending on the specific agreement, the following self-help support:
o General advice to the management on establishing crisis contingency plans at the workplace
o Courses, workshops and talks for staff groups on psychological first aid and collegial support
If you would like to use one or more of the above services, please contact Dansk Krisekorps:
Dansk Krisekorps A/S:
Tel. +45 70 22 76 12 (weekdays 9.00-15.00)
Dansk Krisekorps A/S’s emergency/24-hour service:
Tel. +45 70 22 76 10
Head office Jutland:
Dansk Krisekorps A/S
Sødalsvej 1
DK-8220 Brabrand
Zealand office:
Dansk Krisekorps A/S
Bel Colles Alle 1c
DK-2960 Rungsted Kyst
Email: [email protected]
Web: www.danskkrisekorps.dk
9
Useful links
The following web pages provide helpful information:
Angstforeningen
Information (in Danish) about:
anxiety – stress – phobias
www.angstforeningen.dk
Depressions Foreningen
Information (in Danish) about depression, support groups, theme evenings, research and media.
www.depressionsforeningen.dk
Danish Cancer Society
Read about how to get help, or what to do if you or someone close to you has cancer (in Danish).
www.cancer.dk
Landsforeningen for efterladte
This page provides information (in Danish) on how to obtain help when someone close to you
commits suicide.
www.efterladte.dk
Danish Mental Health Fund
This page provides information (in Danish) on depression, causes, treatment etc.; you can read
personal accounts of dealing with depression and find out where to obtain more information on
depression etc.
www.psykiatrifonden.dk
Danish Health and Medicines Authority
Here you can read about the areas in which the authority is involved which affect most people and
find examples of specific initiatives.
www.sst.dk
Danish eHealth Portal
Provides quick and easy access to the information (some in English) you need as a patient, relation
or employee in the public Danish healthcare service.
www.sundhed.dk
10
Dansk Krisekorps
Dansk Krisekorps A/S is a nationwide company with more than 400 associated psychologists which
is owned and run by the psychologists Mette Nayberg and Morten Holler.
Today, Dansk Krisekorps provides emergency crisis counselling, short-term therapy and stress
management services. Moreover, we organise coaching for managers and employees in many
large private businesses as well as in public organisations, and we are summoned to help groups
or departments resolve conflicts and problems with collaboration. Our services and interventions
are based on long-standing experience from across the organisational and psychological fields of
knowledge. The psychologists are selected on the basis of their qualifications as organisational
psychologists as well as any supplementary training they have received within therapeutic and
crisis/disaster psychology.
For us as owners and daily managers, it is important that the psychologists in Dansk Krisekorps are
highly qualified. We therefore conduct research in collaboration with Aarhus University and hold
courses as well as supervising the psychologists in the course of their assignments. As managers of
the corps, we participate in international conferences and international supplementary training
programmes.
The corps has specialists for assignments abroad, coaching, problems with collaboration, conflicts,
stress management, incest, alcohol, divorce, suicide, depression and neuropsychology.
Our vision:
To be the group of psychologists in Denmark whose clients receive the best services for
their money within psychological crisis interventions, short-term therapy, stress reduction and
coaching as well as conflict resolution and problems with collaboration. Our ambition
is to bring new knowledge to this field of psychology as well as new and efficient ways of working
and intervening.
11
As a service provider, our basic principles are as follows:
o Dansk Krisekorps has a 24-hour emergency telephone manned by a psychologist
o Clients only pay for the services they receive
o The consultation fee for emergency services is the same whatever time of day the psychologist
is called
o Dansk Krisekorps only employs psychologists with experience from both organisations and as
practising therapists
o Dansk Krisekorps provides short-term emergency help in crisis situations
o Dansk Krisekorps offers short-term therapy when this service is needed
o Dansk Krisekorps provides coaching when the contract holder so requests
o Dansk Krisekorps possesses expert knowledge and has many years of experience at solving
problems with collaboration and conflicts. Assignments of this nature are solved on a
consultancy basis under the auspices of Dansk Krisekorps
o Dansk Krisekorps wants to maintain efficient and flexible relations with its clients and is open to
any wishes for changes to its services and ways of collaborating
o Dansk Krisekorps supplies its clients with feedback regarding their own organisations
o Dansk Krisekorps always works with the client in resolving any problems
o Dansk Krisekorps is keen to help prevent e.g. accidents, assaults, robberies as well as stressful
situations via information material, intranet, emergency contingency plans, talks and training
etc.
o Dansk Krisekorps holds talks, workshops and training-based courses
o Dansk Krisekorps compiles data, produces new knowledge and develops new and more
effective forms of intervention for using in, for example, crisis situations
12
General information on crisis help and organisational consultancy
When a violent incident occurs, it is important to take action as follows:
1. The organisation must act
In the event of an accident or assault, it is important that the responsible manager and colleagues
know what to do. This can be ensured by establishing a crisis contingency plan at the workplace.
The victim and other persons in crisis should never have to ask for help, simply because in a crisis
situation it is impossible for people to know what they need.
2. External assistance must arrive soon
It is important that the first meeting with the psychologist happens as soon as possible after the
accident/situation has occurred. The meeting is important to allow the psychologist and the
victim(s) to decide what help is required. The psychological first aid will consist of practical,
psychological and organisational support with a view to helping to mobilise the individual’s and
the group’s resources.
3. Help must be brief and effective – and support self-help
The individual must be prepared for five hours of therapy with the option of fewer or more hours
depending on what is required. The idea behind crisis therapy is that it is quick and effective. The
help provided concentrates on what has happened and looks to the future, because it is, as a rule,
normal people who have suffered an unfortunate incident which has caused an acute crisis. The
help must be supportive of self-help and build on the resources already available to the individual
and the group/organisation as well as the management.
Most agreements will be made between the person from the organisation who contacts Danske
Krisekorps, the victim(s) and the psychologist who has been called in. Morten Holler or Mette
Nayberg become involved in cases where more hours need to be granted or where questions
remain to be clarified.
4. Necessary to pool experience
It is important for the organisation’s learning and the individual employee’s peace of mind that the
necessary experience is drawn from each case – for example, that a written report/procedure is
produced which is known to everybody with a view to preventing or dealing with similar
situations.
5. The psychologist collaborates with the manager and/or contact person
The psychologist collaborates with the organisation and the management on various
recommendations regarding the victim’s work situation such as ‘light jobs’, how the
manager/contact can best support the employee, that the management, contact person and the
staff hold an information meeting and exchange experience about what has happened or that
safety/security procedures should be changed.
13
General guidelines on psychological first aid/emergency help following
accidents and psychological/physical assaults on employees
E.g. explosions, fire, chemical spillages etc.
E.g. assault, robbery, theft, open theft, threats of violence etc.
Emergency:
1. Make sure that the employee (persons involved) is moved to a safe place where he or she will
be undisturbed. Ensure that the person is not left alone, and is not allowed to return to an
empty home.
2. Accept the reactions of the employee (persons involved) – they are normal in such situations.
3. Find out what has happened, ask how the employee is feeling, and keep an eye on how he or
she reacts.
4. Call the appropriate authorities, e.g. the police.
5. Contact Dansk Krisekorps’ 24-hour service
Telephone no. +45 70 22 76 10
Dansk Krisekorps will require the following information: who is involved, what has happened
and how the persons involved are as well as their symptoms. In addition, where the
accident/assault has taken place, when it took place and the name and telephone number of a
contact person. Dansk Krisekorps will then contact a psychologist who will call back and agree
what needs to be done.
6. Explain to the employee (persons involved) that an agreement has been made with a
psychologist and that this is normal procedure in such cases.
Subsequently:
7. It is important that the employee’s immediate superior or the contact person support the
employee (persons involved) so everyone feels they are doing the right thing. For example, if
the psychologist and the manager or contact person make an agreement with the employee
about different working conditions for a period.
8. Ensure that a claims form is completed and that someone contacts the employee’s doctor.
9. In connection with the accident/assault, it is important that the employee’s immediate
superior or contact person keep an eye on the persons involved and their level of well-being.
10. The psychologist works with the employee’s immediate superior or the contact person to
gather experience with a view to assessing whether the current rules/safety procedures are
adequate or whether new rules/guidelines need to be drawn up.
11. If, after six months, there are still physical and/or psychological symptoms such as a
permanent crisis reaction, it is important that the employee is offered further psychological
treatment.
12. For at least a year after the event, it is important that the employee’s immediate superior or
the contact person takes an interest in the physical and mental well-being of the employees
involved.
14
General advice to the management on establishing crisis contingency
plans
Basic questions to the management/contact person when setting out an action plan so that
collegial resources are used to resolve crises:
1.
2.
3.
4.
5.
What needs to happen in the event of a crisis situation?
What are the rights and obligations of the individual employee?
Who is responsible for what needs to be done and how will help be provided?
What form will the follow-up take, both for the individual and at an organisational level?
Does the incident entail changes in relation to behaviour, rules, knowledge as well as
understanding/learning?
6. What information will be provided about the above, and how will it be communicated?
Specific suggestions for procedures in connection with emergency crisis
situations
Before a colleague suffers a crisis, the following must be clarified and communicated to everyone
in the organisation:
1. When crisis help is provided
2. Who is/are the contact person(s) responsible, and who it is that:
o calls Dansk Krisekorps, and thereby a psychologist, and possibly the police/medical
assistance
o plans the light work/relief for the victim and provides support for his or her
immediate colleagues
o keeps an eye on the victim following the incident
o tells the rest of the organisation what has happened, among other things to
prevent rumours
o is responsible for notifying the relevant authorities if necessary, contacting the
safety representative etc.
3. What should colleagues do immediately and in the longer term?
4. Where information is located on crisis help and the name(s) and telephone number(s) of the
responsible manager(s)/contact(s)
5. Where, how often and how the existing safety procedure should be reviewed
When you or a colleague suffer a crisis, the following procedure must be followed:
1. Immediately contact an immediate colleague and the contact person responsible – the
victim(s) must not be left alone.
2. Take the victim(s) to a quiet place;
o be compassionate and listen to them
o accept the various emotional reactions
o immediately after the incident/emergency, never expect the victim(s) themselves
to decide what should happen
o
3. The contact person contacts Dansk Krisekorps and requests psychological help while also
calling the police and the medical services.
15
4. Everyone involved remains on site until an agreement has been made on how to proceed with
the psychologist.
5. The victim(s) must not return home/be left alone for at least the first 24 hours if a course of
action has not been decided upon.
6. The day after the incident, the victim(s), the responsible contact person and the victim’s
immediate superior prepare – ideally in consultation with the psychologist – a ‘light’ work
schedule for the next week, which is then assessed.
7. All employees in the organisation/department are told about what has happened and that the
incident and the person(s) involved have been taken care of.
Own notes
Your psychologist:
Telephone no.:
16
Additional copies of this folder can be ordered from Dansk Krisekorps by sending an email to
[email protected]
The price is DKK 20.00 + VAT and P&P.
Published 2012, version 5
17