Healthcare worker stressed looking through a glass window

In the April 2019 edition of the Bulletin we presented an Overview of Critical Incident Stress Management (CISM). The following article is the first in a six-part series that delves deeper into CISM, the RAPID model and Psychological First Aid.

Psychological First Aid (PFA) is a compassionate and supportive presence designed to mitigate acute distress and asses the need for continued mental health care. PFA is not therapy, diagnosis, or treatment. The John Hopkin’s program has developed an acronym, RAPID, to help guide you through PFA as well as self-care.


Rapport/Reflective/Active Listening
(Everly et al., , 2014)

As members of the healthcare profession, we know that the process of helping others, especially in times of pandemics, disasters (natural or manmade) take a toll on each of us. Using a standardized process to help others in psychological stress will help the person in need and using a self-care model will help ensure we have the stamina, psychological and physical stability to help those in need.

Part 1: Rapport/Reflective/Active Listening

Reflective/Active Listening refers to the ability to utilize active listening techniques, establish empathy, and determine important aspects of the survivor's experience (Everly, McCabe, Semon et al., 2014).

Establishing rapport is an essential first part of any relationship; you are trying to build a trusting and helpful relationship with a person who may be experiencing the worst day of their life. Make contact, introduce yourself, what are you doing and why. Use empathy, an ongoing process that you will use not only during the intervention but throughout your lifetime (Everly, ND).

Reflective listening is effective as it demonstrates that you are understanding the person. Understanding builds trust, and trust empowers compliance. Ensuring that you demonstrate understanding will help your message be heard. Messages without an understanding of who the audience is, are unlikely to be heard, trust is not established, and compliance may not occur (Everly, ND).

How to Begin

Ask a well-phased question.
How does a well-phrased question benefit you?

  • It gives you insight into the person.
  • It gives you insight into their needs.
  • It tells them that you are interested, and not there just to tell people what to do.
  • It sends a message that you are valuable.

Paraphrase the Summary

A paraphrased summary is taking someone else's words and rephrasing them, turning a Yes or No question into an affirmation or modification. Often you will use sayings such as:

  • Sounds to me like
  • What I am hearing you say is

The first and foremost goal of paraphrasing is to establish the concept of empathy. Avoid overuse of these phases. (Everly, ND).

How do you know you are practicing Reflective Listening and not using closed or open-ended questions?

  • Close-ended questions are good for establishing facts.
    • Are you bleeding?
      Do you have a place to stay?
    • Are you okay?
  • Open-ended questions are less efficient at establishing facts but can be more productive.
    • How are you doing?
    • What is going on with you now?
  • Well-phased question
    • I want to help you as best I can; however, I need some more information.

Using the techniques above, what would be the best answer to the following statement:
I lost my house; this house has been in my family for 200 years.

  1. Do you have insurance, perhaps it will cover the house?
  2. So, this has taken your breath away, you have lost more than a house, you have lost history.

If you chose #1, it might be true and the ultimate solution; however, is it what they want to hear at that moment? Is it empathic?

If you chose #2, you are valuing them as a person, letting them know that you are empathic to their situation.

It is important that we “bear witness to someone’s distress”, before they are ready to receive objective assistance. In times of stress and distress, an active, empathic listener is just what the situation calls for.

The next article in the series is Assessment. Each step of the acronym RAPID is essential so be sure to read each of the six articles.

To learn about managing psychological disorders check out this course from PTSD: CARING FOR PATIENTS AND THEIR FAMILIES: The purpose of this course on post-traumatic stress disorder (PTSD) is to educate healthcare professionals on the identification, symptoms, course, and management of PTSD.

Take The Course

Everly, G.S., McCabe, L.O., Semon, N.L., Thompson, C.B, Jonathan, L. (2014). The development of a model of psychological first aid for non–mental health trained public health personnel;

The Johns Hopkins RAPID-PFA.

Everly, G.S. (ND). Welcome to psychological first aid.