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At the time, Gist was an adjunct professor of psychology at the University of Missouri-Kansas City and principal assistant to the director of the Kansas City, Missouri, Fire Department. Today, he lives in Old Briarcliff. A modestly built man with a bristling mustache, he has an expression that tends to make him look a little incredulous and he has a way of talking that takes long, scenic detours.
When Gist talks about trauma counseling before 9/11 — when disaster response and community mental health were considered far less sexy fields of study — he compares it with the monster that Mary Shelley created in Frankenstein, and he brings up the old Irish saying about good intentions paving the road to hell.
Other researchers have also grown suspicious about the effectiveness of treating post-traumatic stress with a technique that has come to be known as "debriefing": forcing the victims or witnesses of a traumatic situation to talk about it with counselors.
Over the last 20 years, grief counseling has become a big business. Almost anyone can say he or she is a grief counselor — it doesn't take a medical degree or a background in psychology. Pop culture has exploded with daytime-talk-show psychology and what Gist calls "touchy-feely" books. So the idea of bringing in an expert — even if the expert was only a self-proclaimed one — to help workers who have seen horrific things seemed reasonable. Most fire departments around the country eventually adopted some system of mandatory group debriefings.
This move to crisis counseling had its roots in the work of Jeffrey Mitchell, a paramedic who invented the techniques while studying for a graduate degree in psychology in 1974. Calling his methods Critical Incident Stress Management (CISM), Mitchell advocated putting first responders who had been exposed to trauma in groups to talk about their feelings, also advising that they eat right, get exercise and rest, and list their behavioral red flags. Today, International Critical Incident Stress Foundation Inc., which trains people in CISM and puts together counseling teams, offers year-round courses in counseling and trauma response for corporations, first responders, pastors, school officials, social workers and therapists, among others. The company's Web site boasts more than 1,000 trainees who have been approved to offer courses on CISM, and the four- to five-day workshops draw an estimated 40,000 people a year. CISM also has foundations in Canada and Australia.
With the market booming, companies that use methods similar to Mitchell's started popping up, offering their services not only to the public sector but also to corporations, claiming that their techniques helped employees cope after on-the-job fatalities or workplace shootings. (Donald Howell, executive director of International Critical Incident Stress Foundation Inc. and press liaison, did not respond to interview requests for this story.)
Among those who embraced trauma debriefings in the beginning but now questions them is Bryan Bledsoe, a clinical professor of emergency medicine at the University of Nevada School of Medicine. Bledsoe started his career as a paramedic before going to medical school. In the late 1980s, he began writing textbooks for paramedics. Like almost everyone else at the time who was trying to find ways to help first responders through difficult situations, Bledsoe included information on trauma debriefing methods.
"We put it in [the textbooks] without looking too much into it," Bledsoe says. "At the time, it was just the best science you could find."
Bledsoe didn't actually see a debriefing in practice until 1991 while working in Maryland. A car had crashed and caught fire, burning four people to death, including two children. As an experienced paramedic, he was familiar with such scenes.