There is a good deal of debate surrounding the efficacy of using debriefing for responders following an incident. Many debriefers find it much easier to work with a prescriptive model. However, the work with those who have experienced a traumatic event is much more complicated than was once thought. The United Kingdom currently does not support debriefing whereas it has been generally embraced within the United States. It has been suggested that a much broader scope must be used in order to deal with differing belief systems and cultural groups. It has also been suggested that concentration needs to be on better responding and follow-up with responders.

It is important to be sure that we do not re-traumatize individuals. An example was given of an individual in Oklahoma involving a Native American. A family had "begged" the survivor to not go to work as her children needed her at home. It was decided, in the tradition of the Native American culture, to hold a Sweat Lodge for the family to help resolve the conflict. The point that was made was that fitting cultural needs and being culturally sensitive must take priority. It is important to be flexible when dealing with traumatized persons, whether they are responders or survivors. When flexible and sensitive, debriefing can be a positive experience. Following the Oklahoma City bombing, the first suicide was that of a police officer. It has been suggested that those who are involved as first responders to crises and critical incidents need not only debriefing, but also long term follow-up. This is true for survivors, families of those involved, and responders.

In some places debriefings are mandatory. This has brought up questions such as "Have I done it wrong?" "Should I not encourage debriefings?", etc. The issue of confidentiality is also important. Discussion has centered on deciding about fitness for duty following a critical incident (e.g. a shooting). These matters should not be related to debriefings themselves. Acceptance of debriefing is up to the individual to attend or not. It is encouraged, but not mandatory. Confidentiality can be maintained. Counselors can educate those in attendance about what signs of post trauma to look for and suggest they seek further assistance if these signs do not go away. Follow-up is always important.

There has been some discussion about the prevalence of PTSD among women. Women are more likely to develop PTSD than men possibly due to a lower level of support and less recuperation time available to women. The support is important for both men and women but in different ways. Women tend to emote better than men. Men tend to verbalize more.

Since the introduction of the CISM/CISD model, the significant negative aspect(s) have been those mental health professionals and others who tout and imply/infer and employ the models as some form or other of "emotional or psychologic therapy". CISM/CISD is not a field of practice. It is not a model of professional mental health practice. It is not a professional mental health practice method. Most importantly, CISM/CISD is not a profession. It is not a professional "identifier", no matter the health and/or occupational profession which one employs to assist persons to conceptualize and put in place a framework of understanding of what has just been experienced within the context of the "moment and human ecological milieu" in which the experience occurred.

Understanding the context(s) within which the model was derived is crucial to an understanding of both the strengths and limitations of CISM/CISD so that expectations of all participants (CISM/CISD providers included) represent it for what it truly is and not as either a substitute for or an identifier of the need for emotional therapeutic "treatment". That some have extended the initially stated intent of the model to include or infer it is or may be a therapy model is a disservice to the receiver of the service and to both individuals and organizations where the model may be helpful in the short term. In this circumstance the influence may be harmful.

As with any methodology, unfortunately, there are those who attempt to extend things beyond the original intent of the method. One of the truly significant aspects of CISM/CISD is that it brings together mental health professionals and first responders, etc. in a way that helps to demystify what psychologists and other mental health professionals actually do. It allows all involved to become familiar with each other - psychologists and mental health practitioners can learn a lot from first responders and others and vice-versa. CISM/CISD, if approached properly, can help develop supportive networks among both groups. It IS NOT a therapeutic technique or method. It should not be made mandatory. If personnel have attended peer training prior to an event, those peers can be the strongest supporters, encouragers, and confidants for their colleagues. Police, Fire, EMTs and others will talk with and listen to peers before managers and supervisors concerning critical incidents. Again, establishing networks and relationships via trainings can provide better responses and acceptance of assistance. Not every person involved in a critical incident responds the same way.

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