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Book Reviews   |    
Psychological Debriefing: Theory, Practice, and Evidence
Reviewed by Carol S. North, M.D., M.P.E.; David E. Pollio, Ph.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.12.1662
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edited by Beverley Raphael and John P. Wilson; Cambridge, England, Cambridge University Press, 2000, 376 pages, $59.95 softcover

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This book tackles head-on the controversial topic of psychological debriefing—not a task for the faint of heart. The introduction addresses the current state of affairs in psychological debriefing, acknowledging the popular embracing of this intervention as a "magic bullet" and the fact that a "trauma industry" that has emerged without the requisite support of scientific backing.

The all-star roster of contributors represents a spectrum of opinions about psychological debriefing. Authors range from Jeffrey Mitchell and George Everly, pioneers of critical incident stress management—who are, not unexpectedly, enthusiastic proponents of debriefing—to Robert Ursano and his group ("if it works, prove it"), who caution that responsible application of debriefing must follow scientific research. Unfortunately, much of the debriefing field today is characterized by the enthusiastic application of models in the absence of clear documentation of long-term benefits.

These prevailing practices and attitudes constituted a substantial challenge to the preparation of this volume. Balanced and well-referenced discussions of the scientific, experiential, and ethical merits and potential drawbacks of debriefing appear along with theoretical models, definitions and descriptions of applications, anecdotal accounts, and reviews of evaluation studies. Pulling together such disparate material into a single coherent document that synthesizes and summarizes the current field required a masterful understanding of the issues, political sensitivity to different kinds of experience and values, and the ability to mesh seemingly divergent models and systems. The book accomplishes the task nicely.

At first glance, we were concerned that the book's attempt to focus on empirical evidence and careful application of debriefing might be lost in the middle chapters' detailed discussions of debriefing for such diverse populations as children and adolescents, hospital staff, victims of motor vehicle accidents, survivors of traumatic childbirth, and Australian Aboriginal people. This concern was dissipated as we read the chapters, however; most provide candid discussions of the scientific evidence for debriefing with the population described.

In chapter after chapter, the authors find insufficient scientific evidence and cite recent negative studies that fail to show that debriefing "works"—that is, that it prevents or reduces psychopathology or improves outcomes. Some authors level criticism at the research for its methodological limitations and for applying the intervention improperly, such as when implementation lacked fidelity to the model or when debriefing facilitators lacked sufficient qualifications.

Throughout the book, the editors carefully maintain a firm grasp on the book's central issue: determining the utility of debriefing and describing its applicability. "Do we need debriefing at all?" they ask in the end. "This is the real question—and it has not yet been fully answered." To date, this book is the definitive source on debriefing. It provides a vast amount of information as well as balanced scientific discussion of potential merits and shortcomings.

Dr. North is with the department of psychiatry in the School of Medicine and Dr. Pollio is with the George Warren Brown School of Social Work at Washington University in St. Louis, Missouri.

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