By Megan Nobert The gap in thorough, balanced, and professional books on the mental health of aid workers is vast. Almost nothing exists in this space. This is not reflective of a lack of necessity for this information though. Quite the contrary, conversations and resources to address the problem of mental health in the aid world are absolutely necessary. As Fiona notes in the beginning of her book, aid work is inherently stressful and traumatizing. To see and experience suffering will never be without impact. Although the book explores some of the most traumatic events an aid worker can experience – being shot at, kidnapped, and raped – this is not at the expense of recognizing the small traumas of aid work. Burnout, accumulated vicarious trauma, and the slid off suffering onto family and friends are not unimportant. Quite the contrary, in the same way that a sudden attack can shock one’s mental health, the slow descent of smaller traumas can be as deadly. The details on available options provided for aid workers experiencing breakdowns in their mental health are concrete and concise. However, the book doesn’t sacrifice accessibility for the academic and professional information, a difficult balance to maintain. Ranging from various forms of trauma counselling to self-care, it presents options for how an individual can recover himself or herself. Mental health is not one-size only, which is made beautifully clear in Fiona’s presentation of different methods for treating mental health issues. What perhaps makes this book not only vital, but astounding, though is the openness in Fiona’s writing. She doesn’t just present the problems of other people, but also her own struggles over the years. She comes from a place of vulnerability and honesty, creating trust in a manner that other versions of a similar text would never reach. She speaks to the deepest parts of our experience, and the professional advice she then gives is all the more poignant for it. We need more conversations like this on mental health in the aid world. This compact book is the first step towards properly addressing a long too abandoned problem. Get your copy of the book today from Amazon. Megan Nobert is the Founder and former Director of Report the Abuse, the first NGO created to address sexual violence against aid workers. As a survivor herself, she has worked to break barriers to reporting, shame, and stigma around the issue.
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Fiona Dunkley, founder of FD Consultants, is passionate about caring for the carers of our world. She is a senior accredited MBACP Psychotherapist, Trauma Specialist, Trainer, Supervisor and Mediator. She is a member of BACP, EMDR, UKRCP and ESTSS. Fiona is the author of, ‘Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Care’, published by Routledge, Taylor and Francis. Fiona has presented on ‘Good Morning Britain’ as a trauma expert, has published several articles and has been asked to speak at various international conferences. Previously Fiona worked within the NHS in forensic sexual violence. She then went onto lead Transport for London’s (TfL) trauma and counselling service soon after the 7/7 bombings. Fiona has worked alongside emergency first responders for many years, including the police, fire service and ambulance services. She worked part-time for InterHealth Worldwide, supporting 500 mission and humanitarian aid organisations, where she was responsible for setting up their trauma and responding in a crisis service. In the last couple of years, she has travelled to Gaziantep, Nairobi and Yangon, Myanmar, where she has offered various psychosocial training programmes. She also offers supervision for teams of staff, such as the Samaritans and CALM, offering trauma and stress awareness, vicarious trauma training and resilience building. Fiona founded FD Consultants one year ago, offering psychosocial support and trauma specialist services for humanitarian aid organisations and individuals that may be suffering from trauma, vicarious trauma, burnout or acute stress. Associates offer consultancy services to strengthen organisations resilience and that of their staff. All associates have over 10 years’ experience in the profession, are highly skilled, and qualified to meet the requirements to work for FD Consultants. They can offer appointments and training in various languages. Associates have experience of working in the mission and humanitarian sector, have worked or lived internationally, facilitate training, have trauma expertise, and have worked with faith-based organisations. Additionally, many associates are trained in TF-CBT and EMDR (trauma specialist counselling recommended by NICE, WHO and APA) and work in crisis management. For a full list of the services provided by FD Consultants please click here The nature of the human spirit is resilient and strong; we thrive for survival against all odds. ‘I couldn’t possibly describe [PTSD] as an illness. All my research, all my years of clinical experience, had led me to believe it was a survival tool: perhaps our ultimate survival tool’ (Turnbull, 2011). Trauma impacts our mind, body and spirit; it invades our internal and external world. Critical incidents, whether man-made or natural disasters, are becoming more prevalent and assiduous, creating a climate of fear. This fear creates a societal trauma spilt, between those becoming more exclusive or inclusive towards our fellow human beings. The core principles of humanity, neutrality, impartiality and independence are more necessary than ever. To heal from trauma, we need a supportive trauma-informed community. As Martin Luther King reflects, ‘we are caught in an inescapable network of mutuality … whatever affects one directly, affects all indirectly’ (Ramalingham, 2013, p. xi). I strongly believe healing communities and countries suffering from trauma will lead to a more cohesive, inclusive and peaceful world. There is the light and dark side of the coin in aid work: the exposure to trauma, and the joy of life. One image that stays with me is ‘the tree of life’. An aid worker in the Ebola clinic in Sierra Leone painted an image of a large tree trunk, and as the children, who had survived Ebola, left the clinic they would paint their hands and leave their handprint, creating leaves on the tree that represent survival: ‘the survival tree’! When we recover from trauma we can dance freely. As the tree that sways freely in the breeze, we all have the right to breathe the air of freedom. Much has been written about ‘post-traumatic growth’ (Joseph, 2011), where individuals who survive trauma become stronger, more resilient and turn the negative experience into something positive to help heal others. A great example of this is the Assistance Association for Political Prisoners (AAPP) based in Yangon, Myanmar, which has trained former political prisoners in counselling to offer psychosocial support to other political prisoners (Michaels, 2014). My experience of PTSD, over 20 years ago, took me on a journey where I transitioned from working in advertising to becoming a trauma specialist therapist, trainer, speaker and writer. I wanted to use my experience to help others and prevent individuals from suffering in silence for years. Findings from the UNHRC mental health guidelines noted: ‘Approximately one-third also indicated some unexpected benefits associated with stress exposure during the course of humanitarian work, including realising they are stronger than they thought, feeling closer to others, deriving more enjoyment from work, and developing stronger religious faith’ (UNHRC, 2013, p. 80). We need to embed psychosocial practices into an organisation’s culture. Trauma exposure is a foreseeable risk, and there is sufficient research to confirm that the impact of trauma exposure can have a detrimental impact on an individual’s mental health, including risk of burnout, acute stress and traumatic stress. The material in my book, Psychosocial Support for Humanitarian Aid Workers, aims to provide guidance to organisations and individuals, and hopefully encourage consistent good quality psychosocial support within the humanitarian aid sector. Let’s lead by example, let’s be at the forefront of good psychosocial and trauma care and let’s ensure that organisations and individuals are competently trauma-informed. Get your copy of the book today from Amazon. The case study below presents a first-hand experience of how EMDR works. I came to therapy after experiencing trauma symptoms following a trip to Turkey where I witnessed a violent failed coup d’état. Despite having triggered the emergency/security protocol while in Turkey, upon my return I was not offered counselling to debrief the incident. The incident was considered important as the executive director and other senior managers were being briefed on my situation twice daily while still in Turkey. In that sense, I did not feel my organisation supported me in dealing with the fall outs of the incident. I had to request for help through HR and it was almost two months before I was able to see a counsellor. Through this experience, I wondered whether other colleagues who may not have been as comfortable going to see a therapist, or afraid of the stigma attached to doing so, would have requested the support. I believe my organisation should make post-incident debriefing mandatory, as part of the incident management protocol. It would help those who may need a little bit more encouragement to seek help. EMDR addressed my PTSD symptoms effectively. It enabled me to understand why I was reacting the way I was, rather than being left to feel weak or stupid for experiencing such distress. It has now been over six months since the treatment and I have not experienced any symptoms in that time. The changes in how I felt and the reduction of the symptoms I was experiencing was quick. I now feel that the issue is resolved and this is not something I will continue to carry with me. (Chris, aid worker) There are several different approaches to psychotherapy, which can be confusing if you are searching for a therapist. It is important to be aware that some therapists will state that they work with trauma but will not have had specialist trauma training. In basic terms there are three main approaches to psychotherapy: Psychodynamic, Humanistic and Cognitive Behavioural therapies. I would describe myself as an Integrative therapist, and therefore I work with a combination of these approaches. Additional trauma specialist models include: Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), Eye Movement Desensitisation Reprocessing (EMDR), Narrative Exposure Therapy (NET) and Sensorimotor Therapy. There are other models of working with trauma but further research is needed into the efficacy of these various approaches. All trauma approaches aim to help the client to create a trauma narrative, find meaning in the event, and reduce the trauma symptoms, whether through talking, drawing, play or writing. Most trauma models follow a three-step treatment programme: stabilisation, processing and integration (Herman, 1997). EMDR: how does it work? Francine Shapiro, PhD, Senior Research Fellow at the Mental Research Institute, Palo Alto, California and Executive Director of the EMDR Institute, California, is the ‘originator and developer’ of EMDR (Shapiro, 1989). Since then, EMDR has been adapted and reworked based on the research and contributions of therapists and researchers the world over. Initially used as a treatment with Vietnam veterans who weren’t recovering, it has since proven successful in treating various other presentations, including anxiety, phobias, addictions, depression, complicated grief, abuse and performance anxiety. The unique feature in EMDR therapy is that it uses bilateral stimulation (BLS) whilst processing the distressing memory (Shapiro, 2005). BLS can be conducted by following the therapist’s hand as it moves from left to right, watching a light bar, or tapping. The same can also be achieved through listening to alternating bilateral tones or holding buzzers. The BLS alleviates negative cognitions, negative emotion and unpleasant physical sensations associated with a traumatic or distressing memory. An important concept of EMDR is the ‘Adaptive Information Processing (AIP)’ theory (Parnell, 2007). This means the client begins to reformulate and update dysfunctional self-beliefs and replaces them with positive self-reflecting beliefs. Therefore, EMDR promotes our innate healing process and reformats dysfunctional information to functional, so that it becomes adaptive information processing. ‘Just as the river flows to the sea and the body heals the wound, EMDR clears the trauma and brings integration and wholeness’ (Parnell, 2007, p. 6). In discussing EMDR, Professor Gordon Turnbull states: ‘Therapists and patients were reporting that problems that had been resistant to years of psychotherapy were being resolved in a very short amount of time – sometimes within a few sessions’ (Turnbull, 2011). In my experience of working within the field of trauma for over 15 years I have never witnessed such a powerful and successful way of working with traumatised and anxious clients: ‘EMDR works effectively and helps the client return to work quickly and safely after a traumatic event’ (Dunkley & Claridge, 2012). The EMDR protocol sets out an eight-phase treatment plan:
For more information on EMDR Treatment I encourage you to buy my new book Psychosocial Support for Humanitarian Aid Workers, available via Amazon. |
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