Psych Services: Disaster counseling: A case of a team of experts not being an expert team

Lisa Garmezy

A deployment in December with a Red Cross Disaster Mental Health team started me thinking about what makes teams work. Whatever it was, we lacked it. Our group was living proof that a team of experts is not an expert team.

 

As individuals, we made significant contributions. My colleagues and I were honored to volunteer in what was left of Paradise, California, and in the shelters established nearby for victims of the Camp Fire. Three adjacent buildings on the county fairgrounds housed about 400 traumatized people.

 

We didn’t gel as a team. With our 10-day or two-week deployments, someone was always coming or going. We weren’t necessarily team players, either. Police officers tend to seek camaraderie; we are used to working alone.

 

The future is about teams—in business, in the military, in health care, in space, and on campus. Rice University psychologist Eduardo Salas has written, “Much of modern-day work cannot be done without teams or larger collectives.”

 

When work is assigned to teams, rather than individuals, the members can back each other up, find each other’s mistakes, enforce ethical standards, and shift the workload around as needed. Teams are more adaptable than individuals, e.g., when a client requests changes midproject. The whole is more than the sum of the parts: teams get more done.

 

We were a great bunch of people with a compelling mission. In hindsight, our obvious mistake was not clarifying our goals in the shelters.  We cared deeply but didn’t always agree on the best path forward.

 

Put Me to Work

 

Some of us thought that the most urgent task was—I won’t say putting out fires—trouble-shooting. I calmed couples who could no longer stand the sight of each other and residents who lost track of their psychiatric meds. When the fire marshal insisted on clearer aisles between cots, I soothed clients who grew belligerent because their few remaining possessions were being taken to “storage” – wherever that was. Keeping the shelters reasonably peaceful reduced everyone’s stress level, staff and clients alike.

 

That’s why I was flabbergasted when a colleague said, “We’re not here to calm people down.” She felt our main task was motivating the residents through on-the-fly counseling sessions. A month in, the shelter felt relatively comfortable to some. “Have you thought about where you’re going next?” was a critical question.

 

According to Red Cross philosophy, we were both wrong. The organization teaches that mental health professionals’ main focus at disaster scenes should be the well-being of other Red Cross volunteers. We weren’t approached much about staff concerns, however, since they—and we—were milling around like unherdable cats trying to meet the basic needs of clients.

 

All three goals have unquestionable merit. Not prioritizing them made it harder to feel something was accomplished. The lack of an agenda makes the reasons for working seem vague, leading to discouraged worker bees.

 

When goals are clear, team members work more energetically and persistently. They have a “shared scoreboard.” Without it, they don’t know when they’ve done well.

 

Building on Trust

 

One study of interagency emergency response teams identified four key challenges: trust, communication, competition within and across professions (a little bit can be healthy), and clear understanding on the part of each team member of his or her role. For example, on a scene, you have to trust that the people with other jobs—e.g., when containing a chemical spill—are working as hard as you are. That actually takes two kinds of trust—trust that they have the right skills and trust that they care enough to do the job well.

 

Teams with decent leadership, clear goals and adequate skills can still flounder. A third type of trust, psychological safety, makes or breaks teams. Call it mutual respect, if you prefer. When team members cannot open up in front of others to give and receive feedback, teams do not become the flexible, self-correcting groups described above.

 

With trust, the best teams are self-healing. Team debriefings pull out lessons learned, improving the group’s performance. Properly conducted, debriefings can relieve the stress of emotionally-draining work. It’s good to confess missteps and hear a concerned person say, “We all make mistakes; you’re human; you did a great job overall,” or words to that effect. Even a joke from a colleague can say, reassuringly, “Don’t take things too seriously; the world will keep turning in spite of our triumphs or failures.”

 

I’m not sure my team got to that point, although some instant friendships felt very supportive. We didn’t vent much to each other.

 

Different goals meant different challenges and different levels of frustration. Therapists who microfocused on trying to fix favored clients’ chaotic lives took on impossible tasks, and they buckled under the strain. It wasn’t my first rodeo, so for me, living in a basketball gym with 80 other volunteers was more challenging than the workload.

 

For Next Time

 

A better plan would have helped. Consistency would have helped. Expectations about seeking permission and reporting changed when a new supervisor came on board. That’s not unusual, but it was frustrating. Some lessons of previous disasters were ignored, and old mistakes were repeated unnecessarily.

 

Under very difficult circumstances, a lot of committed volunteers did what they could. We’re human. The world will still turn. And I hope I have the opportunity to deploy with the Red Cross in the future and do it all again.