Survivors of war, terrorism, abuse, rape, or natural disasters are treated through stress management programs (Meichenbaum, 1994; Wolfolk & Lehrer, 1993), which help the survivors to adopt new coping strategies by means of cognitive therapy, reframing, relaxation, and assertive training. When a whole community is exposed to a stressful event or disaster, group debriefing sessions typically take place to help its members regain control. In debriefing, participants are guided to express their personal experience, thoughts, emotions, and behavior concerning a shared stressful recent event. Critical incident stress debriefing (CISD) sessions were first suggested by Jeffrey Mitchell (1983, 1993) as a means of therapy, and many others have since developed variations of the model (e.g., Williams et al., 1994). Meichenbaum (2001) summarized the phases of the debriefing model, which has received much attention, as follows: (a) Introductory phase: ground rules are laid, (b) Fact phase: the facilitator and the participants are encouraged to establish what happened, (c) Thought (Cognition) phase: thoughts about what happened are discussed, (d) Reaction (Feeling) phase: emotions associated with the event are discussed, (e) Symptom phase: the participants describe signs and symptoms of distress, (f) Teaching (Educational) phase: “normality” of the reactions is emphasized along with information about useful coping strategies, and (g) Re-entry (Wind-down) phase: discussion of outstanding issues; summary statements and additional advice are offered (Meichenbaum, 2001, p. 515).

Expression of thoughts and emotions is central in debriefing work. This expression may be verbal through conversation, or sensory or metaphoric through the medium of creative activity. When the stressor is human, such as a rapist, a terrorist, or an enemy, survivors typically experience anger, rage, and a desire to take revenge on the abuser (Thorman, 1983). Debriefing therefore typically encourages the clients to express and deal with the anger and hatred in order to regaining control of the situation and the integrity of the self.

Despite the widespread use of debriefing models , some scholars questioned the efficacy of the debriefing and claimed that studies have failed to demonstrate a consistent relationship between early intervention and outcome (Hiley-Young & Gerrity, 1994; Meichenbaum, 2001; Orner, & Schnyder, 2003). Raphael, Meldrum and McFarlane (1995) called for systemic evaluation of the effectiveness of debriefing intervention. In a recent meta-analysis aimed to assess the efficacy of CISD, Van Emmerik, Kamphuis, Hulsbosch, & Emmelkamp (2002) found that this intervention has no efficacy in reducing symptoms of post-traumatic stress disorder, and was no more effective than other non-CISD interventions or even no more effective than not intervening at all. The effect size for symptoms of post-traumatic stress was lower for CISD than for non-CISD interventions and for not intervening.

Based on the published studies of debriefing using comparison groups, McFarlane (1994) noted some potential dangers and claimed that the debriefing work may aggravate the condition of some of the participants. Raphael, McFarlane and Meldam (1994, unpublished manuscript cited in Meichenbaum, 2001, p. 517) raise the possibility that: “debriefing may lead to secondary traumatization … there have been some reports of people feeling they were worse after debriefing, upset or not helped” (p. 20). In addition, CISD may interfere with natural processing of habituation and coping, leading to victims bypassing the support of family, friends, and other resources of social support and professional care (Van Emmerik et al., 2002).

Gist & Devilly (2002) claimed that meta-analyses were done on studies with general population rather than within the specific occupational setting in which the debriefing originated. To enhance the efficacy of debriefing, they suggested specific structured interventions tailored to the needs, context, and course of individual resolution; interventions that allow assessment to identify those at greater risk and that incorporate a variety of psychosocial interventions and cognitive behavioral therapy. For further readings on alternative treatments see Meichenbaum (2001) section V.

In addition to the aforementioned limitations of the debriefing model, there is a cultural concern which is crucial among many collective cultures . In the typical stressful situations in which debriefing was used in therapy, the source of the stress, typically, was external (enemy, terrorist, rapist or hurricane) and not a part of, or connected to, the survivor’s identity or self. One can therefore assume in these cases that the expression of feelings and thoughts, including anger, may help to restore the integrity of the self in facing the stressful “other.” In many other stressful situations, however, especially such as a collective people may experience, the stressor is part of the collective self and lives side by side with the victim within the boundaries of a shared in-group. In these situations the debriefing model should be carefully analyzed and revised. This manuscript analyzes the unique difficulties involved in applying the debriefing model in collective societies, presenting the Palestinian-Arabs in Israel (Palestinian-AIs) as a representative case. Based on this analysis, preliminary directive ideas are offered whose consideration is recommended when dealing with stress management in collective societies. Finally, a case study will be presented.

Psycho-cultural features of collective societies

Unlike individualistic societies where the individual is recognized as an independent entity who has an individuated self, in collective societies an individual adopts a collective identity or self. One is not individuated from the in-group, such as family or tribe. The individual’s in-group relationship is characterized by interdependence. She relies on her family or tribe to meet her basic survival needs and also her psychological needs such as safety, love, belonging and esteem (Dwairy, 1998a, 1998b; Kitayama, Markus, Matsumoto & Norasakkunkit, 1997). She shares the values, attitudes, feelings, and destiny of her collective. Identity among collective societies is defined by relationships and group membership rather than by personal experiences or characteristics. The emotions tend to be other-focused rather than ego-focused. Individual members of collective societies think often about the needs of their in-group and consider them to be more important than their own (Dwairy, 2002; Triandis, 1995; Sue & Sue, 1990). The main source of stress in these societies is the pressure or the abuse experienced within the collective life and the strategies used to cope with it are also collective such as protect the family rather than the individual (Baker & Shalhoub-Kevorkian, 1999; Dwairy, 2002).

In most stressful events experienced in collective societies, the stressor is related to or part of the collective identity. This kind of internal source of stress is very threatening for people who live in a collective sociocultural system and who possess a collective identity. The Palestinian-Arabs in Israel present a good case to exemplify the nature of stress in collective societies, since they experience some kinds of stress, the source of which is typically not external but rather represented in the survivor’s identity. This was the case, for example, when the Palestinian-Arabs in Israel faced the Iraqi (Arab) threat in 1990. Despite this fact, the main policy of the Israeli Ministry of Education is to implement the group-debriefing procedure in Palestinian-AI schools when they encounter community-wide stress (Mosa, 2001), regardless of the socio-cultural characteristics of Palestinian-AI. In the case of most of these stresses, debriefing interventions may generate the inter-group tension and intra-personal conflicts described in the following section.

The collective identity of Palestinian-AIs: Palestinian-AIs are those Palestinians who remained in their homeland when it became the State of Israel in 1948. As a minority they have multifaceted collective identities: They are Palestinians, Arabs, and Israeli citizens, and among them are Muslims, Christians, and Druze (a sect derived from Islam) . The collective identity of Palestinian-AIs consists of five different components: (a) National identity as Palestinian-Arabs: Palestinian-AIs are part of the Arab world and the Palestinian Arab nation and share its history, culture, and destiny (Dwairy, 1998b; Rabinowitz & Abu Baker, 2002), (b) Citizen identity as Israelis: Palestinian-AIs are Israeli citizens and a significant Israeli component is included in their identity (Rabinowitz & Abu Baker, 2002; Samooha, 1992, 1996), (c) Religious identity: The vast majority of Palestinian-AIs are Muslims (80%), the rest being Christians (13%) or Druze (7%). Religion plays a significant role in their lives and comprises a significant component of their identities (Dwairy, 1998b; Samooha, 1992), (d) Familial identity: Palestinian-AIs live in a collective socio-cultural system, fostering a strong affiliation with their family that cares for their needs. This reciprocal individual-family care is vital in areas such as employment or housing, where the state of Israel discriminates against its Palestinian Arab citizens and does not meet all of their needs (Dwairy, 1998a, 1998b). The familial identity therefore overshadows the individual’s self (Dwairy, 2002), and (e) Local identity: Palestinian-AIs feel a strong affiliation with their village, neighborhood and physical environment (Baker & Shalhoub-Kevorkian, 1999; Dwairy, 2001). Typically they continue to live in the same village generation after generation. If they emigrate from their village they preserve their province affiliation, adopting the name of their former village as their family name (Abu Baker, 1999; Dwairy, 1998a, 1998b). For further reading on Palestinian-AIs see Rabinowitz and Abu Baker (2002).

Stresses among Palestinian-AIs

During the last decades, Palestinian-AIs have been exposed to particular kinds of threat that have several implications on the implementation of the debriefing model.

1) The stressor is part of the collective self: conflicts among the interests of each group to which Palestinian-AIs feel affiliated result in clashes occurring among these groups and traumatize some Palestinian-AIs placing them under physical threat. The main kinds of stresses to which Palestinian-AIs were exposed in the last decade, involving loss of innocent people’s lives, are: (a) Attacks from an Arab country during war, or attacks armed Palestinian on Israeli targets where Palestinian-AIs habituate: Here the stressor and the victim are from the same nationality and religion. One of the Palestinian-AI leaders best described the situation in which Palestinian-AIs found themselves as a result of the continuing Israeli-Arab conflict: “my nation is at war with my country,” (b) Clashes between Palestinian-AI extended families: In this case the stressor is typically from the same national, citizenship, religious, and local circles as that of the survivor, (c) Clashes between one Palestinian-AI religious group and another: Here, the stressor and the victim are from the same national, citizenship, and local circles, and (d) Clashes between Israeli policemen and soldiers and Palestinian-AI citizens: Here too the stressor and the survivor are of the same Israeli citizenship.

In all these stressful situations, the “enemy” represents one group to which the Palestinian-AI “victims” are affiliated. The threat is, therefore, dual in nature: it is a physical threat as well as a threat to the integrity of the collective self and identities. Therefore, implementation of the debriefing model and facilitating the expression of anger toward the stressor may escalate an intra-psychic conflict between the components of the survivor’s identity. In this case debriefing opens an intra-identity conflict that is associated with deep guilt and seems unsolvable in a typical debriefing session. Because there are individual, gender, and age differences in the development of the collective identity, it is expected that the severity of the intra-identity conflict that may be generated in the debriefing will vary from one individual to another. This conflict is expected to be moderate among some people who adopt a less crystallized collective identity.

In some respects, these stressful situations are similar to incest. Unlike stress that is caused by an external threat, in both cases - incest and stress in collective societies - the stressor is represented within the survivor’s self, and therefore guilt and negative self-concept are two major results (Berry, 1975; Browning & Boatman, 1977). It seems safe to assume that Palestinian-AIs feel guilt and that their collective self-concept is damaged when they experience these kinds of stress. In these cases, anger directed at the abuser is actually also directed at the self, and, therefore, fragmentation of the collective self are actually the natural results.

2) Collective experience and coping: The vast majority of stress management programs in the west are self-oriented and focused on the way the individual copes with stress. A large part of these programs addresses the intra-psychic domain concerning the individual’s resources, coping techniques, and defense mechanisms (Meichenbaum, 1994; Wolfolk & Lehrer, 1993). The stresses among Palestinian-AIs targeted a group to which the individual is affiliated, such as family, religious group, nation, or citizenship. The experience as well as the method of coping with stressful events is collective rather than individualistic. Adequate coping for Palestinian-AIs is to think, feel, and behave in a way that protects and maintains the collective affiliation, identity, and social and religious values. Therefore, stress management programs should be adapted to fit this collective system and to address the intra-group domain as well as the intra-psychic one.

When the two conflicting parties are living together within the boundaries of a shared in-group, or learning in the same school, a sectoral setting for debriefing within homogeneous groups will preclude the confrontations during the procedure that may be provoked in a classroom setting. This may be achieved through cooperation between the clinicians and the leadership of the family or the religious group. Each extended family (or religion group) may be debriefed separately at the beginning of the process. If the two conflicting groups reach a point where they are able to listen to each other and work out the conflict, a carefully managed bilateral meeting may take place to resolve the conflicts as described in the following.

Conflict resolution programs, which may include both peer and adult mediation problem solving, appear to be of some merit in reducing violent behavior (e.g., Wilson-Brewer & Spivak, 1994). Peer mediation in the schools is used with documented evidence of its beneficial effects (e.g., Johnson & Johnson, 1991). Students can be trained to be mediators to assist in conflict resolution. They can learn to listen to and understand the disputants, to specify rules, and to engage the disputants in deciding what they can do to agree on a problem solution (Lane & McWhirter, 1992).

Conflict resolution training may be most beneficially used as a prevention tool before the stressful event and when the learned skills are applied within the stress management program after the stressful event had occurred. Ideas from the aforementioned conflict resolution programs as well as from the endogenous cultural mechanisms of conflict resolution may be incorporated. Sulha is an Arabic mechanism of reconciliation between two parties in which a third party, comprising an agreed-upon group of respected people, mediates and the two parties a priori declare their acceptance of the solution of the mediators (see Abu-Nemer, 1999).

The Principal of the school arranged a consultation meeting with the psychologist, social worker, educational counselor, major educators, and other members of the community leadership. It was clear that applying debriefing sessions at school and in the community might escalate the confrontations. The following plan was set and implemented:

First week: Community preparation and trust building to facilitate sectoral debriefing.

Meeting the heads of the families. The Principal, psychologist, and social worker, in addition to Muslim religious (the Sheikh) and Local Municipal Council representatives, met with the heads of each family to appeal for their help in excluding the children from the circle of adult conflict and to ask them to allow educational-therapeutic interventions concerning the stress to take place in the classrooms. The meetings were held in the house of one of the elder persons in each family. The families responded positively to the visit. They wanted to hear details about the interventions in classrooms. When they understood that separate meetings would be held at the school with the children of each family respectively, they gave their support to the initiative. The main obstacle was that each family made their agreement conditional upon the a-priori agreement of the other side. When this condition was fulfilled each side agreed to convey to their children that: “children should be outside the circle of conflict” and should not attack or bother any child from the opposing side. Both families insisted that normal communication or cooperation with the children of the opposite family is still premature at this stage.

Sulha attempt. During this first week the Shiek and other community leaders continued to lead negotiations between the two families in order to achieve Sulha (agreement between the families). This goal was not easy but the difficulty did not deter the psychologists and social workers from working with the children in school, while the efforts for Sulha continued.

Meeting the teachers. The psychologist and the social worker met separately with two small groups of teachers who were involved in the conflict. They were informed of the agreement that had been made with each family and were asked to back up this agreement in the school. After a mini debriefing session, they were able to agree and said: “We respect the will of the family.”

Meeting the students. Children of each family who learned in different classes met separately with a psychologist , educational counselor, and the Principal of the school. One group consisted of 25 students and the other of 23 students. The Principal mentioned the agreement with the families that had been achieved, according to which the children should be “outside the circle of conflict.” Some children affirmed that their fathers had conveyed this message to them. At this point the psychologist and the counselor led a typical debriefing session. In each group, children shared their experiences during the events with each other and expressed their thoughts and emotions. Knowing the difficulty of Arab students to express feelings regarding familial events publicly, the psychologist and the counselor legitimized individual differences and allowed each child to participate according to his own pace. In addition, the children were offered the choice of expressing their experiences and feelings either verbally or metaphorically in drawings or art works. Younger children preferred to draw. Much anxiety and many aggressive indicators were found in their drawings. Older students expressed themselves more often verbally. They expressed anger and fear and some children expressed feelings of loss and guilt. One student (9 years old) expressed her guilt feelings caused by the fact that she had been obliged to end her relationship with her best friend who was her cousin from the opposite side. She cried when she told the group how, on her way to school, she avoided meeting her uncle with whom she had had a very good relationship just a month before. Similar expressions were heard from other participants. Another student (8 years old) said that he no longer trusted anybody; all those whom he had loved before had turned in a moment into enemies who threatened him and his family. Another (Ali, 13 years old) expressed his anger and hatred toward some people affiliated to the other family and then he said very sadly: “Actually I hate myself. I would not believe that I have this hatred for Sami,” his former friend ( Names used are fictitious ).

Each of these meetings lasted for about three hours. At the end the participants expressed their need to meet again and continue in this activity.

Week two: Strengthening trust and cooperation

Second meeting with the students. A second meeting was held with each group. In this meeting more students became ready to share their experiences and participate in the debriefing and the art work. The emotional expressions became less angry, and more positive feelings were expressed. Some students were able to express their need to communicate with the other side again, and felt regretful about the prohibition that was enforced by their parents. However, despite the eagerness of some of them to renew the relationship, all but one chose to adhere to the prohibition enforced by their parents. Only Ali, who had expressed his guilty feelings caused by his hatred, said that he would consider a talk with Sami.

Second teachers’ meeting. A meeting with all of the teachers was held. All of them reported improvement in the behavior, concentration, participation, and achievement of the students in the classrooms. The clashes had stopped and no fearfulness was observed.

Second meeting with the families. Despite the fact that the Sulha had not yet reached a successful conclusion, the psychologist, social worker, and the Principal met with the heads of each family, again separately. They reported the general process that took place in the debriefing sessions to the families and informed them of the improvement that was being seen in the behavior and achievement of the students, attributing it to the cooperation and support of the family. The family was satisfied with this report and was less suspicious than before. Ali’s father said that he knew that his son had talked to Sami. Although the father seemed not to be satisfied with the change, he accepted it because he felt it is inevitable. The social worker expressed his appreciation of the father’s tolerance and the psychologist rephrased the commendation as “generous fatherhood.” Basing his action on the positive atmosphere in these meetings, the Principal sought the permission of the family to allow a shared educational activity concerning the relationship between the students. After a discussion, they agreed to this suggestion on the condition that it would be limited to the classroom, but still insisted on prohibiting normal relationships at homes outside the school. After this meeting the psychologist as well as the social worker felt that the families might be ready to tolerate much more than they were ready to admit and might tolerate a renewal of the relationship outside the classrooms too.

Weeks three and four: Bilateral debriefing and implementing conflict resolution skills.

Shared debriefing and conflict resolution activity. Five shared age-matched meetings were arranged in which the psychologist and the educational counselor served as guides. To these shared meetings, which were held after school hours, each student was encouraged to bring another student whom she wished to accompany her. 18-23 students attended each meeting, half of whom were from among the two conflicting families and half of whom were their friends, not affiliated to the two family branches in conflict, who were guided in acting as conciliators. At the beginning of each meeting the guides expressed their appreciation of the families’ and children’s cooperation in fulfilling the policy of “excluding the children from the circle of conflict” that they had agreed on in advance. The children were informed that the present shared meeting was being held with the permission and the backing of their families. The children were then encouraged to share their feelings about the present shared meeting. Most of the responses were positive toward the shared meeting and some were indifferent. No one expressed negative feelings. After about thirty minutes the guides asked the children to express their thoughts regarding such questions as “How do you wish to communicate with each other in school?” “Are you ready to talk together about the school” “Do you want to play together in the school yard?” “Do you feel OK about coming to school together?” The guides divided the group into three small groups: two consisting of the students from each family and the third consisting of the accompanying friends who served as conciliators. They directed both family groups to discuss these questions exclusively for half an hour and then to report their answers to the conciliators. While these family discussions were ensuing, the guides discussed with the conciliators how to handle the situation. The conciliators were eager to see the relationship return to normal and were enthusiastic about persuading each side to move toward that goal. The guides directed them to listen to each group and to try to understand their feelings first before pushing for a normalization of relationships. After the two conflicting parties ended their discussions, the whole group assembled again. Each party reported what they had agreed upon within its respective group. The two conflicting parties expressed reserved readiness to move toward a normal relationship. They reported too that some of them rejected any contact with the other side. The differences between the reports put forward by either group were minor. So that the oppositional consensus within the groups would crumble, the guides justified and encouraged individual differences within each group and asked each to respect the other’s attitude. At this point the guides asked the conciliators to express their hopes regarding the groups’ relationships. When the two conflicting parties heard the eagerness of their friends for normalization, their reservation was moderated and more students began to say explicitly that they wanted to return to normal relations. The meeting ended in a fully accepted agreement being made to respect each child’s choice without taking notice who wanted to return to normal relations and who did not. On their way out, many students were seen communicating with the opposite side. Obviously, at this point the consensus had crumbled.

Weeks five to nine: Employing ideas from the incest model in individual work.

Individual counseling. During the group meetings six students had expressed guilt feelings because of their anger at the other side. Four of these were among those who rejected a renewal of the relationship with the other side. The two others were those who did renew the relationship but in doing so felt guilty and that they were betraying their parents. The psychologist held individual meetings with each child to deal with the guilt. Conflicting feelings, that are typical to incest victims, such as love and hatred, anger and guilt, and low self-regard and self-devaluation and shame were expressed. The process in these meetings was very similar to that used to deal with the conflict and guilt of incest victims (Kearney-Cooke & Striegel-Moore, 1994; Zaidi, 1994). The students dealt with the conflict between their personal needs and their parents’ expectations. Some of them expressed anger toward the parents who had caused this conflict, and guilt feelings because of that anger. This process lasted for two to seven meetings, after which the students felt relieved and satisfied with their decision, regardless of whether they renewed the relationship or not. The community leaders continued in the Sulha negotiations between the two families. After six months they reached a Sulha agreement.

Week 10: Evaluation meeting.

The Principal arranged an evaluation meeting with all the parties who had attended the planning meeting. All the participants were satisfied with the results. Many emphasized the importance of including the families in the plan, arranging separated meetings, and including the friends as conciliators, and some compared this process to former debriefing interventions that had failed, resulting only in an escalation of the conflicts. The participants were enthusiastic to continue this culturally sensitive line of stress management intervention.