The Sport Psychologist, 2005, 19, 288-302 © 2005 Human Kinetics, Inc.

The author is with the Department of Educational Leadership and Human Development Counseling, Bradley University, Peoria, IL 61625. E-mail: [email protected].

Team Consultation Following an Athleteʼs Suicide: A Crisis

Intervention Model

Kathleen J. Buchko Bradley University

This article presents a three-phase model that can guide sport psychologists assisting in crisis intervention with athletes in the weeks following a major trauma. The model employs a systems theory framework within which therapeutic tasks that facilitate recovery from trauma are offered. The unique role of the sport psychologist in post-traumatic care of athletes is discussed. The modelʼs utility is illustrated via retrospective application to the authorʼs work with a team that experienced the suicide of one of its veteran members.1

Practitioners of sport psychology may very suddenly find themselves consultants to a team that has suffered tragedy such as the sudden death of a teammate (Vernacchia, Reardon, & Templin, 1997), or, as in this authorʼs case, an athleteʼs suicide. Such events may be of relatively low incidence in sport (Brown & Blanton, 2002; Ferron, Narring, Cauderay, & Michaud, 1999; Tester, Watkins, & Rouse, 1999), but they have great impact upon athletes and coaches when they do occur. Research suggests that with effective intervention, many people can recover from acute traumatic stress within 6 to 8 weeks (Foa & Riggs, 1995; Tierney & Baisden, 1979). This paper presents a model for time-limited (6-12 week) crisis intervention that can be used with sport teams in the aftermath of a traumatic event.

The article arose from the authorʼs retrospective evaluation of her own interventions with a womenʼs basketball team which, just prior to the start of its season, experienced the suicide of one of their veteran players. At the time of the tragedy, the author found herself being guided mainly by clinical intuition in helping traumatized athletes. It is hoped that the model presented will aid sport psychologists in times of trauma by providing a template for specifi c and systematic crisis intervention. Further, the article builds upon a foundation laid by Vernacchia and colleagues (1997), who introduced Critical Incident Stress Debriefi ng (CISD)

Professional Practice

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to sport psychology. CISD is a method for managing acute crisis reactions that these authors applied in their work with a grieving team following a teammateʼs sudden death. In the conclusion to their article, the authors emphasized a need for services beyond the acute phase of trauma, and what follows is an attempt to extend sport-specifi c crisis intervention beyond the immediate post-event period.

After outlining the assumptions inherent in systemic crisis intervention, the author presents a model that delineates some 16 therapeutic tasks. This list of interventions is given sequentially, but because post-traumatic crises are rarely linear in presentation, the tasks are most useful as a “menu” from which the sport psychologist and care team can select according to need. The author uses case material from her own crisis work to illustrate application of the helping tasks in a sport-specifi c setting.

Systemic Crisis Intervention: Theoretical Components

Current Model The Systemic Crisis Intervention model presented herein was developed by Brown and Rainer (2002). Originating from work with distressed families, the model has been developed for use in communities hit by disaster and in organizations where trauma has occurred. As such, the model can be adapted for use with sport teams that have suffered a catastrophic event. To fully utilize the model, sport psychologists need an understanding of its theoretical components.

Systems Theory The model presented herein is based in systems theory (Bertalanffy, 1966), which views human groups such as families, communities, or sport teams as interacting such that “the behavior of one member inevitably infl uences all the others” (Berg- Cross, 2000, p. 41). To illustrate the operation of a system in a sport context, imagine a point guard on a college basketball team who becomes depressed after receiving bad news from home. She is irritable and “has words” with a forward on the team. Angered, the wing tells several of her teammates, who begin to give the depressed guard “the silent treatment.” The guard retaliates by not passing to the forward as often in play. Teamwork suffers, losses result, and these create diffi culty between coaches and between the head coach and the athletic director. Thus, even under normal conditions, distress for one individual can impact the entire system of relationships that make up the team. Under post-traumatic conditions, relations within a system may serve to amplify distress, when, for example, the reaction of one witness to a catastrophe “infects” others (Miller, 1998).

On the other hand, systems can also become powerful sources of restoration following crises (Hillman 2002; Miller, 1998). A clinician who utilizes a systems approach seeks to understand interactions between individuals and the system as a whole and between subgroups and the system. The systemic interventionist “‘fl oats ̓ between individual psychological and social levels of investigation” (Atwood, 2001, p. 2). A sport psychologist utilizing a systems approach with the basketball team described above would identify the confl ict between the guard and the forward that was disrupting teamwork. The sport psychologist would also evaluate the guardʼs depression and refer for treatment, if necessary. A team meeting to air issues and

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build cohesion would address the team s̓ snubbing the guard. The sport psychologist might also attempt to work with other confl icts (e.g., coach-coach, coach-Athletic Director) within the larger team-athletic department system.

Three additional assumptions of systems theory need to be elucidated. First, systems theorists posit that relationships within a system function according to rules, roles, and rituals (Brown & Rainer, 2002). Rules (often unspoken) govern what system members “should” or “should not” do or say (Satir, 1988). Roles defi ne how each individual fi ts into and contributes to the system. Rituals are sets of actions that symbolize shared connections between system members.

A second systems theory assumption is that balance is sought between all members and subgroups in a system so as to create a smooth-running equilibrium or homeostasis (Bertalanffy, 1966). Human systems draw upon rules, roles, and rituals to achieve and maintain homeostasis. In the basketball example cited above, when the depressed guard becomes quiet, the “rule” among teammates may be to “give her space.” The guardʼs demeanor, however, upsets the teamʼs homeostatic balance, and another player, sensitive to emotional changes in her team, may enact her role as a “cut-up” to bring laughter and relieve tension.

Thirdly, systems theorists assume that contained within any system are the potential resources to establish homeostasis. In working with the distressed basketball team, the sport psychologist would draw upon resources such as caring about performance and the desire to learn from mistakes to help the team restore homeostatic balance. The crisis intervention model presented herein is based upon a systemic understanding of post-crisis dynamics and upon systemic interventions.

Crisis Intervention Theory Crisis intervention theory operates upon two basic assumptions that are similar to those of systems theory. These are (a) that individuals and groups in crisis experience a loss of equilibrium that will return with assistance and (b) that the return to equilibrium can be accomplished by identifying and mobilizing resources already contained within the crisis-stricken individual or group. Problems displayed by a person or group in crisis are thus viewed as evidence of temporary immobilization of resources, not as psychopathology. This view gives rise to a second assumption: it is the job of the crisis clinician to augment the resources of the distressed person or system and then to gradually assist a return to self-reliance. The methods crisis clinicians utilize span the gamut of therapeutic tools, ranging from solution-focused strategies to trauma reprocessing methods. The main skills that guide crisis clinicians, however, are fl exibility, therapeutic creativity, and a strong conviction that while crises may include chaos, they also contain seeds of potential for new growth.

The Systemic Crisis Intervention Model: Therapeutic Tasks and Their Application In a Sports –Related Crisis

Overview of Model The model is comprised of three action phases, each containing several therapeutic tasks. The fi rst phase, Remembering, focuses on helping victims to process the crisis together. Such processing helps surmount the human tendency to withdraw from painful stimuli and to avoid reminders of the event that trigger fear. Such

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A Model for Crisis Intervention • 291

reactions, if they become entrenched, can lead to intense, intrusive recollections of the event, which are a hallmark of Post-Traumatic Stress Disorder (PTSD; American Psychiatric Association, 2000).

Victims of trauma may avoid openly discussing their experiences because they feel isolated and the experience seems too painful to recall alone, or because they wish to protect teammates or others from their feelings (Janoff-Bulman, 1992; Henschen & Heil, 1992). Recalling the event with others who also experienced it, however, creates mutual support, corrects initial distortion, and allows for clarifi cation of common reactions such as survivor guilt (Hillman, 2002; Janoff- Bulman, 1992; Miller, 1998). As the initial shock wears off, a second action phase, Reorganization, becomes paramount. The main objectives of this phase of healing are to help the traumatized system and its members to access their own strengths and to shore these up with outside resources where needed. The aims of the reorganization phase are that individuals can begin to feel safe and in healthy control again and that the system itself begins to regain a sense of balance.

The fi nal phase of recovery in systemic crisis intervention is Restoration. In this phase, the crisis clinician helps system members review strengths and accomplishments vis-à-vis the crisis, assists in addressing any ongoing needs, and arranges for his or her own exit from the interventionist role. The model presented here by Brown and Rainer (2002) gives an overview of the systemic crisis intervention model (Table 1), showing the three action phases described above and identifying the therapeutic tasks that facilitate each phase.

The therapeutic tasks that are to be described constitute a menu from which to select according to the needs of the team, rather than a sequence which must be worked through in linear fashion. Each of the action phases and their accompanying

Table 1 Overview of Systemic Crisis Intervention Model, Phases, and Therapeutic Tasks

Phase I: Remember 1. Share the story. 2. Validate the emotional impact. 3. Evaluate the context of the crisis. 4. Protect vulnerable family member(s). 5. Negotiate a solvable problem. 6. Network with relevant resources.

Phase II: Reorganize 1. Formulate a plan for change. 2. Identify developmental issues. 3. Engage therapeutic tools. 4. Assign homework. 5. Support systemic rules, roles, and rituals.

Phase III: Restore 1. Track progress toward goals. 2. Acknowledge indicators of the time to terminate. 3. Address future sources of stress. 4. Refer for continuing treatment. 5. Exit the system.

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therapeutic tasks will now be described and application will be made showing how selected tasks were used in a sport crisis.

Phase 1: Remembering A brief description of the therapeutic tasks involved in facilitating Phase 1 is provided in Table 2.

Case Illustration of Phase 1. The author, a faculty member and doctoral- level counselor with sport psychology and crisis intervention training, had been about to begin consultations to a womenʼs basketball team during fall practice. One week before practice was to begin, a veteran player committed suicide. Her body was discovered by her roommate who was also a member of the team. Within a few hours, the author was asked by the athletic director to be the primary consultant for the team during the crisis. Thus, what had begun as a performance enhancement consultation, suddenly turned to a role as liaison between the athletic department and coaches and the network of campus counselors, the student health center physician, and community-based psychologists, psychiatrists, and counselors who treated the distressed athletes.

Table 2 Description of Therapeutic Tasks and Helping Roles in the Remembering Phase of Systemic Crisis Intervention

Therapeutic Tasks Helping Roles

1. Share the story. Helpers guide survivors to tell, retell events in increasing detail to facilitate gradual incorporation of the experience into consciousness.

2. Validate emotional Survivors are helped to acknowledge, express feelings in impact. ways that fi t for them; less dominant/ vocal members are drawn out by helpers.

3. Evaluate the context of Helpers investigate precrisis relationships within the the crisis. system; gauge precrisis strengths, weaknesses of system; help survivors work through any preexisting problems that have been exacerbated by trauma.

4. Protect vulnerable Assess nature and extent of risks (e.g., loss-related member(s). depression, harm to self/ others) to each member of the system; intervene to reduce risk.

5. Negotiate a solvable Helpers assess degree of shock-related disorganization, problem. then facilitate move toward self-reliance by identifying appropriate concrete goal(s) for individuals and the system to accomplish.

6. Network with relevant Identify and mobilize natural leaders within system; link to resources. outside resources (e.g., psychological, medical, legal) as needed.

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The author began her preparations for post-traumatic care with the team by fi rst refl ecting upon the relational context in which this crisis had occurred (see Table 2, Task 3). First, the coaches were all new to the team. Several of the coaches had worked together at another university. The team itself was small. It was comprised of six returning veterans, two players who had transferred from junior colleges, and one freshman. In considering relational context, the author realized that the assistant athletic director and an athletic trainer actually were more familiar with the team than were the coaches. These staff members would be important sources of information about the team, especially which athletes had traditionally played what roles on the team (e.g., “spokesperson,” “sparkplug/motivator,” “comedienne/ tension-breaker”). The author also reasoned that potential sources of strength in team relations might come from mutual support among the veteran players, who, as recognized leaders, might help stabilize the team, given appropriate support. The coaches could also support each other, having coached together elsewhere. Potential liabilities lay in relations between coaches and veterans and between veterans and transfer starters.

The second crisis intervention task undertaken by the author was to assist in “protecting the vulnerable” (Table 2, Task 4). The morning after the suicide, the author met with the assistant athletic director, the coaches, the trainer, and several therapists from the student counseling center. The major purpose of the meeting was to “triage” each member of the team by identifying her degree of risk, according to criteria developed by the author in conjunction with student counselors. These were relational closeness to the deceased, her proximity to the discovery of the suicide, and the degree of social support she had at present.

Relational closeness was selected as a primary risk factor because of research that persons closest to an individual who commits suicide are at greatest risk of experiencing extreme guilt and severe depression (Hipple, Cimbolic, & Peterson, 1980; Stillion, 1996). Proximity to discovery of the deceased was chosen due to concern with a contagion effect in which the extreme distress of those closest to the event amplifi es the reactions of others, and vice versa (Chemtob, Tomas, Law, & Cremniter, 1997; Tierney & Baisden, 1979). Degree of social support was decided upon because of previous fi ndings that emphasize its importance in recovery from trauma (e.g., Solomon, 1986).

Each athlete was identifi ed as being at serious, moderate, or lesser risk based on the three factors. Those with the highest risk rating were referred for assessment to a clinical psychologist or a psychiatrist in the community. A plan for coaches to support each athlete was also developed. The deceased athleteʼs roommate, who had discovered her body, was of particular concern. It was decided that this young woman would be advised that she could go home if she wished or could stay on and meet with a psychotherapist in the community (she chose the latter).

By the end of the triage meeting, all athletes had been assigned to follow-up by coaches and care by either student counseling center personnel or community therapists. Unfortunately, the triage meeting was the only time the author and other caregivers met face to face. After that, the author obtained releases of information and kept in touch by telephone with the various caregivers each week. This was very time-consuming. In retrospect, a team approach in which caregivers met weekly to discuss progress would have been much better than the network approach developed by the author. A team approach to care is, thus, highly recommended in sport crises.

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In many sport-related crises, the athletes will not be the only members of the system who are vulnerable and need support. Coaches, too, may be at risk, particularly due to the “double hit” of dealing with their own grief while trying to help their athletes (Miller, 1998; Vernacchia et al., 1997). In this context, coaches may be subject to both vicarious traumatization (Saakvitne & Pearlman, 1996), from their interactions with distressed athletes, and compassion fatigue (Figley, 1995) from over-identifi cation with athletes in their care. In the case presented herein, the coaches ̓newness to the team actually seemed to insulate them somewhat, enabling them to be supportive of the traumatized athletes.

Another aspect of protecting the vulnerable in a sport crisis may be that of screening from the media. In the authorʼs crisis involvement, the media did not pursue athletes for interviews. Sport psychologists who work with teams in other crises may fi nd the media to be intrusive, and it may be essential to brief both athletes and coaches on how to handle media attention in a crisis. A very thorough, brief primer for handling media attention in a crisis has been developed at the University of Central Oklahoma (Clark, 2003) and is available on the universityʼs website.

Much of the work of remembering in the initial period after a crisis may be addressed through one or more Critical Incident Stress Debriefi ngs (CISDs). Application of the CISD model in a sport related crisis has been addressed very effectively by Vernacchia and colleagues (1997). In the authorʼs crisis experience, the therapeutic tasks inherent in remembering, such as sharing the story and validating emotional impact, were done initially in sessions with the team and student counseling center staff. The author initially helped with these recovery tasks on a one-to-one basis with a number of the athletes and several of the coaches, but did not get directly involved with CISD. In retrospect, this was a fortunate turn of events, because within a few days of the suicide, the team “closed ranks” (Vernacchia et al., 1997). They thanked the counseling center crisis staff for their work, but determined that they would carry on from here. While individual athletes continued to be seen by counselors during and after the season, no outside interventionists met with the team concerning the suicide after those fi rst few days.

The phenomenon of a team “closing ranks” necessitates the sport psychologist s̓ thought early-on, about “exiting the system,” a therapeutic task that usually comes near the end of crisis intervention (refer to Table 1). Since presumably, the sport psychologist wishes to continue to be of service to the team, she or he must execute a “partial exit” from the system of relationships that forms early-on between CISD interventionists and the sport team. In the immediate aftermath of crisis, an intense but (in the authorʼs experience) brief relationship may develop between the CISD team and the sport team. The best role for the sport psychologist may be “behind the scenes” assistance on a one-to-one basis, as needed. The phenomenon of groups distancing themselves from outside help that they had embraced during an initial period of chaos has been noted in the literature (Kennedy, 1981; Schulman, 1990). In the author s̓ observation, the team became increasingly less willing to discuss the trauma per se, and this was especially the case with persons outside team life.

Systemic Crisis Interventionists assert that negotiating solvable, concrete problems helps trauma survivors move from initial helplessness toward self- reliance (Brown & Rainer, 2002; see Table 2, Task 5). Athletes soon encounter a ready-made problem: what to do about playing (or continuing) the season. The decision to play their season appeared, in the authorʼs view, to reconnect athletes with something of the familiar (pre-crisis) world (Janoff-Bulman, 1992). They

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displayed determination and visible relief when this decision was made. This initial “performance resolve” (Vernacchia et al., 1997) seemed to make players more eager to talk about their game than about the larger-than-life events that had just occurred. Here the author seemed to play a crucial role in the care network, that of bridging the gap between the “old” familiar world of sport and the “new” post-crisis world, where emotional reactions needed to be processed. This was the case in the authorʼs experience, because when players actually took to the court, they found the initial performance resolve disrupted due to acute post-traumatic symptoms, such as inability to concentrate, loss of attention, and sudden paralysis in decision making. When these occurred, athletes were initially hit hard, because, as several of them stated, it now seemed that even the familiar world was out of control. Athletes accepted input from the author about the normalcy and potential transitory nature of the acute symptoms. They asked, however, to focus on how to overcome the symptoms in order to play their game. To the casual observer, it may seem inappropriate to work on sport performance with people who have only recently experienced catastrophe, but from the athletes ̓and coaches ̓requests, the author speculated that they may have preferred to focus primarily on their game for two reasons. First, team play and sport focus may have provided athletes with needed senses of attachment and belonging that have been shown to be important for recovery from trauma (Garbarino, Kostelny, & Dubrow, 1991; Nader, 1997). Second, the sport setting may have provided a means for alternately facing and defocusing team acute stress symptoms, a combination known to aid in trauma processing (Janoff-Bulman, 1992).

Phase II: Reorganizing

In the Reorganizing phase of crisis intervention, clinicians help traumatized individuals and the community as a whole to recover basic psychic survival skills and competencies. Table 3 describes the therapeutic tasks and goals that can help a team reorganize in the wake of trauma.

Case Illustration of Phase II Tasks. In the authorʼs post-trauma consultation, a signifi cant degree of overlap was observed between therapeutic tasks described in Phase I and those of Phase II. For example, as noted earlier, an initial consolidation occurred around the resolve to play the season. As the team moved into preseason practice, however, a number of athletes displayed or described a loss of focus and energy. During brief consultations before practice, the author discussed grief reactions with the team. The team was encouraged to discuss both the trauma and their beliefs and feelings about its impact on their play. The author purposely linked trauma processing with sport performance because it was observed that the athletes stayed with discussion of their collective grief longer when it was set in the context of effects on play. The author speculated that connecting trauma reactions with sport performance gave athletes a familiar framework from which to reconstruct “an assumptive world in which events are meaningful and make sense” (Janoff-Bulman, 1992, p. 117). Indeed, the author received feedback from other caregivers that athletes had voiced both greater understanding of the normalcy of post-traumatic reactions and an increased sense that they could work through these reactions as a result of team meetings.

An early Phase II therapeutic task undertaken by the author was that of identifying developmental issues (see Table 3, Task 2). Early-on, the “developmental

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age” of the team as a whole was assessed as “young” by the author. This was primarily because there were not any seniors, and the three veterans and two junior college transfers who would start had little experience playing together. In terms of prior individual time on the court, however, both the veterans and the transfers would be described as “seasoned.” An early challenge inherent in reorganization, then, was how to help this traumatized team mature together relationally.

The author observed that two of the veterans and one of the transfers emerged in roles as unoffi cial leaders who were spokespersons for the team. One of these leaders actually voiced anger at the deceased in one of only a handful of references that were made to her all season. The author also noted that one of the transfers had a great sense of humor and used it to break tension during practice sessions.

Familiar team roles and rituals were supported in several ways during team meetings (Table 2, task 5). First, natural leaders were called upon for insights on a regular basis. Second, an unspoken rule, that anger feelings would be visited upon persons outside the team but not upon teammates, was left unchallenged. Third, the author sought to align team members by pointing out when the feelings expressed by a veteran were similar to those voiced by a transfer, or vice versa. Finally, the author “borrowed” the comic phrase of the team comedienne on several occasions to emphasize a point in discussion. Gradually, the team appeared to relax together. This was refl ected in their pace and patterns of play as well.

Table 3 Therapeutic Tasks and Helping Roles in the Reorganizing Phase of Systemic Crisis Intervention

Therapeutic Tasks Helping Roles

1. Formulate a plan for Helpers assist system in working through change. expectable feelings of demoralization; reorient system to its own strengths by identifying concrete, attainable steps toward recovery.

2. Identify developmental Identifi cation of developmental life stages of individuals issues. and overall maturity of system (e.g., how long have they worked together?); helpers utilize inherent system strengths to promote growth.

3. Engage therapeutic tools. Helpers employ theoretically sound methods with which they have experience creatively and fl exibly to promote individual/systemic growth and recovery.

4. Assign homework. Individuals and the system are assisted in regaining self- monitoring/self-effi cacy skills that facilitate relearning of safety and adaptive coping; specifi c tasks to do on their own are given; expectations and fears are discussed; outcomes are monitored.

5. Support systemic rules, Precrisis behaviors/ catch-phrases that symbolized stability roles, and rituals. and togetherness are identifi ed; systemʼs return to homeostasis is enhanced by drawing out/applying positive and familiar modes of interaction.

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The necessity of using therapeutic tools (Table 3, Task 3) with individual players became apparent as the team prepared to open their season. In practices leading up to the fi rst game, angry, anxious reactions that seemed in excess of the seriousness of the error were observed. It was likely that one mistake would prompt a series of them. If players were taken out and “benched” to allow them to “regroup,” most hung their heads in what appeared to be responses of shame. Players often ignored the encouraging remarks of teammates. Again, notably, no anger was expressed toward each other when mistakes were made.

In discussions with the athletes, the author again interpreted these strong individual reactions in terms of acute traumatic stress. Survivors of trauma can have both exaggerated startle responses and strong reactions to stimuli that prompt feelings of anxiety or isolation, similar to those engendered by the trauma (American Psychiatric Association, 2000). The author saw the athletes ̓reactions to mistakes as responses to being startled out of the “illusion” of early performance resolve. Now, as the time for their public debut approached, the stakes for playing well appeared to rise by several orders of magnitude, and mistakes prompted anxiety, shame, and for some, dissociative phenomena, such as sudden feelings of the unreality of self or surroundings.

The author applied various individually-tailored therapeutic tools (Table 3, Task 3) to help athletes to reduce anxiety and refocus after a mistake. To reduce feelings of isolation and shame (“I seem to be the only one making these stupid mistakes” was a common statement) the author gave the team “homework” (Table 3, Task 4) by having players “catch each other doing well” and offer encouragement before errors were made, rather than only afterward. During “chalk talks” with the team, players were encouraged to consider errors as signals of “the start of a brand new ball game.” Errors decreased in the weeks that followed, and the “shamed” behavior seen earlier stopped. The relatively rapid disappearance of reactive behavior led the author to speculate that these responses had, indeed, been signs of acute traumatic stress that were now remitting for most of the players. This observation was signifi cant, because prior research (Harvey & Bryant, 1998) has suggested that externalized reactions of hyper-reactivity and irritability, if displayed during the acute post-traumatic period, are indicative of a non-pathological stress response. Such acute responses signal a normative reaction that may not develop further into Post-Traumatic Stress Disorder (PTSD; Harvey & Bryant, 1998). Based on this data, the author was able to alert the caregivers of those athletes who continued to display more internalized, dissociative reactions and who might have been at greater risk of developing PTSD.

At the outset of their season, the team won fi ve straight games. Just as it seemed that they were “coming together” as a team, however, a string of six losses occurred. The athletes then asked the author for help in functioning better as a unit. They believed that the losses had not been due to individual errors but to a lack of team focus at crucial points in the game. The author viewed this request for help as being signifi cant on two points. First, from a developmental point of view, this request signaled relational maturation as a team. Readiness to work more closely together also seemed to herald the teamʼs renewed performance resolve (Buchko, 2004; Vernacchia et al., 1997). Whereas the team s̓ initial resolve to play their season seemed to have been based on an attempt to cling to something of the familiar precrisis world, this revitalized determination was based upon playing experience and, as such, seemed to be more reality-based.

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The author responded to the athletes ̓ request for team-building by fi rst helping them formulate a plan for change (see Table 3, Task 1). Within this plan the players devised a verbal cue (“beef it out”) as a signal to refocus as a team. Of note in the present discussion is that by working their plan for team-building, this team, which had sustained a devastating pre-season blow, secured a spot in their conference tournament.

Phase III: Restoring In this last facet of the systemic crisis intervention model, the interventionist

completes the process of restoring autonomy to those she or he has been helping. Restoration has two connotations in this setting. First, it means returning to individual survivors of the crisis the full responsibility for carrying on with life. Continued treatment is available for those who would benefi t from it. Potential stress-points in the near-term and the larger future are identifi ed and are considered in the light of newly acquired coping skills. The second aspect of restoration refl ects the clinicianʼs attention to leaving the system strengthened and aware of both its inherent strengths and its newfound homeostasis. Table 4 offers descriptions of the fi nal therapeutic tasks that facilitate restoration.

Table 4 Tasks and Helping Behaviors in the Restoring Phase of Systemic Crisis Intervention

Therapeutic Tasks Helping Behaviors

1. Track progress toward Helpers evaluate headway toward identifi ed goals; goals. anticipate resistance to change and interpret this as a signal to adjust rate of change or modify types of change that support continued recovery.

2. Acknowledge signs of Recognize attainment of “new normal” by the system; time to terminate review gains with system members and prepare system to services. move on autonomously; acknowledge any needs that remain.

3. Address future Identify and predict potential future stressors (e.g., stress-points. anniversary of crisis); help individuals anticipate/ apply coping skills if these arise; teach system to expect challenges to recovery and empower to meet these via references to current coping successes.

4. Refer for continuous Helpers set clear boundaries about what they can/cannot do treatment. long-term; appropriate referrals for long-term care are made as needed.

5. Exit the system. Helpers celebrate system successes, underscoring autonomous growth, then terminate or redefi ne helping roles.

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Case Illustration of Phase III Tasks. The first therapeutic task in restoration, that of tracking progress toward goals for growth (Table 4, Task 1), centers on anticipating and spotting resistance to change and then helping both individual athletes and the team overcome resistance and achieve their goals. In the authorʼs experience, resistance was encountered at two levels. First, individual athletes had trouble applying the stress reduction skills offered. They believed that if they just “hit it harder,” they could eliminate the stress responses. Second, the team was initially resistive to devising a verbal cue to refocus as a unit during play. They too believed that if they each would just “bear down,” their collective second effort would “carry the day.”

These individual and team resistances illustrate that a system that has been disrupted by trauma often is reluctant to leave the security of tried and true beliefs. If the sport psychologist sees resistance as being a naturally-occurring part of growth rather than a negative sign, then it can be effectively managed in a sport- related crisis. In the case of the athletes who had trouble applying cognitive stress management skills and who “just (wanted to) hit it harder,” the authorʼs agreement with their statement about hitting it harder with the addition of “and smarter” helped them overcome and accept the new skills. Athletes were empowered to work from what they knew (i.e., how to hustle in competition) to incorporate skills for handling intrusive traumatic phenomena. Similarly, when the team initially resisted devising a verbal cue to refocus, the author was able to help them surmount this resistance. This was accomplished by “letting them speak their language rather than her language.” Thus, rather than clinical-sounding cue words like “focus” or “energize,” the team chose the phrase “beef it out.” The cue was established and the resistance was overcome.

In the authorʼs experience, acknowledgment of time for termination (Table 3, Task 2) was, to some extent, already dictated by the end of the season. The last team meetings were aimed at reviewing the teamʼs remarkable achievements in surmounting the emotional aftermath of the suicide over the course of the season and at addressing future stress points. The author noted that in reviewing their accomplishments, the women did not mention the deceased. Instead, they focused on their attachment to each other, with only oblique references to their trauma. Typical of these comments were the words of one player who said, “I learned that, with great teammates, you can overcome some very tough things and still have a good season.” The author chose not to probe for more direct discussion of the trauma based on feedback from the athletes ̓individual caregivers. Nearly all caregivers had reported that few or no symptoms of acute stress remained in their clients. Thus, the teamʼs emphasis on attachment to each other appeared to be a genuine acknowledgement of systemic strength rather than collusion to avoid distressing topics.

In individual sessions, the author probed more specifi cally for the athleteʼs feelings and thoughts regarding the suicide. Two related themes that emerged from these interactions were continued anger at the deceased for not reaching out and sadness that the athlete had not had the chance to do something that could have helped her teammate. The author gently asked athletes what the suicide had taught them about life and/or about themselves. As with the fi ndings of other investigators, a common theme was that the suicide had made athletes more aware of the fragility of life (Henschen & Heil, 1992).

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300

Future stress points (Table 3, Task 3) were discussed with the team in terms of anniversary reactions. The idea was presented that certain times of year (e.g., just prior to the season) and certain dates might trigger feelings such as sadness, irritation, fearfulness, or numbness. These reactions were normalized, and encouragement was given to use deep breathing and healthy self-talk (e.g., “this is a normal reaction, I can work through it”) to manage them. Athletes were also encouraged to talk the feelings through with a coach, past or present, or other safe and trusted older adults.

The recurrence of dissociative phenomena, such as feelings of the unreality of self or surroundings or of intrusive traumatic imagery, was described as a signal of the need to see a counselor. This recommendation was given because recurrent dissociation has been identifi ed as a sign of impeded recovery from trauma (Foa & Hearst-Ikeda, 1996) and of the development of Post-Traumatic Stress Disorder in traumatic bereavement (Raphael & Martinek, 1997). The author made sure that each athlete had her offi ce and home telephone numbers and her university e-mail address. The offer was made that if desired, athletes could contact the author at any time to assess whether they might benefi t from further care by either university counselors or community-based psychologists or psychiatrists (See Table 4, Task 4).

With this partial exit from her role as consultant, the authorʼs work with the team ended until the following season (Table 4, Task 5). It was very rewarding to attend the post-season athletic banquet. Several of the athletes acknowledged the authorʼs interventions as having been helpful to them personally and to the team as a whole. Most rewarding of all was to hear and observe the expressions of accomplishment described by each speaker. These athletes were truly members of a tight-knit system, brought closer by trauma.

Conclusion

This paper has offered a crisis intervention model that sport psychologists can employ to manage acute traumatic stress reactions following major emergencies that a sport team might experience. Use of the model has been illustrated in a retrospective discussion of the authorʼs interventions with a basketball team in the wake of a veteran member s̓ suicide. It is important to reiterate that a team approach utilizing other qualifi ed health professionals is an imperative in managing crises in sport. Further, if a sport psychologist has not been clinically trained and/or has not received additional training in Critical Incident Stress Management (CISM), he or she should enlist help from a colleague who has had such training.

Regarding research, the author s̓ observation of athletes ̓determination to play their sport in the aftermath of a tragedy involving their team needs to be replicated. The case presented herein is now the second report of such performance resolve, the fi rst having been reported by Vernacchia and colleagues (1997). If the resolve to play continues to be observed in a variety of settings, it could be considered part of a sport-specifi c model of bereavement (Vernacchia et al., 1997). Moreover, the authorʼs speculations about the roles sport performance and teamwork may play in helping athletes manage acute traumatic responses await empirical verifi cation. Additional research needs to be done with male athletic teams in the acute period following traumatic loss in order to determine how their reactions compare with those of women. Finally, the Systemic Crisis Intervention Model itself needs further study, both as to its general utility with athletes and as to the relative contributions

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of its component therapeutic tasks to recovery from traumatic events in sport. Nonetheless, the model appears, at this point, to be useful for care of teams during periods of acute traumatic stress.

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Author Note 1Informed consent was provided by the athletes in this article. Personal information and

the team make-up was altered to preserve anonymity of the individual players.

Manuscript submitted: January 23, 2004 Revision received: April 29, 2005

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