A recent study published by PLOS ONE and carried out by a number of esteemed psychologists has found that Eye Movement Desensitisation and Reprocessing (EMDR) appeared to be the most cost effective intervention for adults with PTSD. Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. A considerable proportion of people exposed to trauma, around 5.6%, will develop post-traumatic stress disorder (PTSD) [1]. For staff in the Humanitarian sector and emergency first responders research has suggested PTSD is as high as 30%. 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. 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. 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. 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). FD Consultants are trained in the recommended (WHO, APA and NICE) treatments of trauma and PTSD which are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). We have worked extensively with emergency first responders and aid workers globally to combat PTSD and vicarious trauma. All associates have over 10 years’ experience in the profession, are highly skilled, and qualified to meet the requirements to work for FD Consultants. We can offer appointments and training in various languages. Associates have experience of working with the humanitarian sector, emergency first responders and mental health charities. They have worked or lived internationally, facilitate training, and have trauma expertise; making them perfectly placed to support a broad cross-section of society and organisations. Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. References 1. Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med. 2017; 47(13):2260–74. https://doi.org/10.1017/S0033291717000708 PMID: 28385165
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Throughout July and August FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. This week, Fiona Dunkley, the founder of FD Consultants, gives an overview of the specialisms and criteria required for the high calibre of associates. FD CONSULTANTS is a global psychological health consultancy and focuses on caring for the carers of our world. FD Consultants offer services to client organisations in the Humanitarian Sector, Emergency First responders, Mental Health Charities, and Journalists. We have recently supported the wellbeing of staff working for the Information Technology and Artificial Intelligence professions, due to the risk of exposure to online traumatic material. There is a lot of miscommunication and misunderstanding in psychological trauma care. There are many therapists that say they work with trauma who are not specialists and are not trained in evidence-based models. FD Consultants are unique as the founder is a senior accredited BACP psychotherapist, trauma specialist, trainer, supervisor, mediator and author. This means FD Consultants are led by an expert in the field. We are not focused on becoming a large Employee Assistance Programme, as we want to offer a specialist and relational service. FD Consultants want to make the world a better place, alongside the client organisations we work for. Our values are Creativity, Compassion and Collaboration. We strongly believe in a collaborative approach to working and promote a multi-lateral, multi-sectoral service that works across prevention, treatment and rehabilitation services. FD Consultants is a network of over 50 global specialist therapists. All associates are highly skilled, experienced and qualified to meet the requirements to work for FD Consultants. We only take associates with over 10 years’ experience and have “accredited” status (country dependant). We offer appointments and training in over 20 languages. Associates have experience of working in the humanitarian sector, have worked or lived internationally, facilitate training, and have trauma expertise. Due to the high calibre of associates we have many qualified supervisors, senior accredited members, training of trainers (TOT), and management/leadership consultants. Additionally, some associates are trained in TF-CBT and EMDR (trauma specialist counselling recommended by NICE, WHO and APA) and work in crisis management. FD Consultants model of psychosocial support is well tested in the private, public and charity sector. We offer an evidence-based and tailored programme of psychological services that cover public health frameworks of wellbeing, i.e. across prevention, treatment and rehabilitation. As most of our associates have worked in other careers before retraining as therapists, we have a good understanding of the sectors we work in. Many associates have previous careers in, human rights law, refugee and asylum support, FGM, LGBTI+, civil unrest, gender-based violence, racial injustice, false imprisonment, sexual violence, slavery, human trafficking, natural disasters and pandemics, torture, prison services, police, ambulance and fire fighters, educational settings, forensics, journalists, and INGOs, to name a few. Some extracts taken from our previous posts over the last two months showcasing FD Consultants associates: I joined FD Consultants at the start of 2019 with an academic and professional background in the fields of human rights, international development and gender-based violence (GBV) and with a clinical focus on refugees and trauma. Having lived internationally, in the Middle East, Balkans and in Europe during these years, I also had some knowledge of the aid sector field context … At FD Consultants we attend to each of our clients with trauma specialist expertise and an understanding of the unique contexts in which humanitarian, human rights staff and first responders work. Most recently, as part of the COVID-19 humanitarian response, FD Consultants’ Associates have been carrying out consultations with humanitarian aid staff preparing to deploy, the majority of whom are well seasoned in epidemic emergency settings… By building relationships with these organisations, providing individual services to their staff and, by providing vital monitoring and evaluation, FD Consultants directly contributes to achieving the goals and objectives of the humanitarian sector through enhancing its duty of care policies (Arianna Rondos, UKCP accredited psychotherapist with over 10 years’ experience). "I've been involved with FD Consultants from the outset and it has brought a really interesting variety of work my way. This has ranged from psychological 'health-checks' with young people setting off to volunteer overseas, to initial trauma assessments with organisational staff who have been involved in traumatic incidents, to psychological reviews with individuals returning from particularly challenging international assignments. Over recent months, working with individuals who have been relocated, or whose roles have changed significantly due to the coronavirus pandemic has been especially interesting (Felicity Runchman, BACP accredited psychotherapist with over 10 years’ experience). “Researchers have found that those using the Trauma Informed Care (TIC) approach within organisations have better informed staff on Trauma awareness, they provide more of an emphasis on emotional and physical safety, they promote opportunities to rebuild control and provide a ‘strengths-based approach – helping to support and identify strengths and coping mechanisms. During my work with FD Consultants, I have witnessed the TIR approach... Recognising the Covid-19 Crisis as another traumatic event in so many ways, I have been working with Fiona to roll-out a programme of trainings to help staff and managers work through their issues, from stress management through to a Crisis Management approach” (Claire Pooley a senior BACP accredited psychotherapist, Traumatologist, Accredited EMDR Practitioner, Supervisor and Trainer with over 30 years’ experience). “Fiona is an incredible and motivated individual with a true passion for supporting the carers of our world. I have had the pleasure to work with Fiona on a wide range of research projects, and Fiona's professionalism, attention to detail and willingness to go above and beyond to meet client organisation's needs are a rare find in the sector. Fiona challenges organisations to think bigger and be better in supporting their staff's mental health needs. FD Consultants provide high quality, bespoke and professional trauma informed mental health services, and consultancy” (Yasmin Lee, Public health Consultants, Mental Health, HIV & Covid-19). Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. Throughout July and August FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. This week, the founder of FD Consultants, Fiona Dunkley, shares some of her background and expertise. FIONA DUNKLEY MBACP (Snr. Accred) UKRCP ESTSS EMDR is passionate about caring for the carers of our world and therefore founded FD Consultants which is a global psychological health consultancy. Fiona is a senior accredited BACP psychotherapist, trauma specialist, trainer, supervisor and mediator. Fiona has presented on television and radio as a trauma expert, has published several articles and has been asked to speak at various international conferences. Fiona is a published author, ‘Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Care’, published by Routledge (Dunkley, 2018). Fiona shares her experience of how FD Consultants originated. I began to see a thread of similar characteristics in the types of people that signed up for caring roles. These characteristics included being passionate, caring, and resilient, but also sacrificial and overlooking of their own self-care, over-working, and holding unhealthy boundaries. Although the tapestry created by weaving together these threads created a dynamic, vibrant, compassionate picture of humanity and hope, the underside showed a much darker, chaotic and disturbing picture with many loose ends ready to unravel from one crisis to the next. This underside resulted in staff experiencing burnout, anxiety, stress, and suffering from vicarious trauma and Post-Traumatic Stress Disorder (PTSD). I started my counselling career in the National Health Service (NHS) working in a Forensic Sexual Assault unit, often supporting individuals subjected to human trafficking. At times, I worked night shifts, and once I received a call out, I had to arrive at the hospital within one hour. I witnessed dedicated medical staff suffering from burnout and worked alongside Police Officers experiencing Post-Traumatic Stress Disorder (PTSD). It was also evident that people in these caring roles had not received sufficient training in the psychological impact of trauma. I witnessed this lack of training impacting not only the quality of treatment offered to survivors, but also the detrimental effect on the member of staff’s own mental health and wellbeing. This reminded me of the time, in my early twenties, when I was knocked unconscious whilst I had gone to the aid of someone else being attacked. I gained consciousness in the ambulance and as I was asked my name by the paramedics, I realised I had no idea who I was. How strange not to be able to answer that question. As I arrived in the hospital the suspected diagnosis was concussion and a fractured skull. As I was rushed through the Emergency and Accident unit, in hindsight, I can identify that the medical staff taking care of me at the time could also have benefited from further training in the impact of psychological trauma. The medical model mainly being focused on recovery from the physical impact of trauma. The nurse preparing me for x-ray became annoyed with me as I couldn’t stop shaking, stating, “you need to keep still for the x-ray to work”. Other members of staff came to hunt me out and whispered behind their hands, “she is the one who went to help someone else being attacked”. No one explained I would be projectile vomiting throughout the night, have lights shone in my eyes every hour, and not be able to move my jaw up and down. On discharge from the hospital, I received no signposting to psychological services or explanation of the symptoms of Post-Traumatic Stress Disorder. As a psychotherapist specialising in trauma, I now know how crucial it is for someone’s recovery that they are supported during those first few days after a traumatic event. At FD Consultants we advise and train staff in how to offer psychological first aid to colleagues directly after a critical incident. We offer guidance to managers to reduce the risk of re-traumatising their staff and how to support someone back into the workplace. We offer training to leadership teams in crisis management and implementing best practice evidence-based trauma management and wellbeing programmes into an organisation. After working four years in the NHS, I joined Transport for London (TfL) as the lead counsellor of an inhouse trauma and counselling service. I had arrived soon after the 7/7 London bombings. The counselling team had been successful in supporting staff back to work, but who had taken care of the counselling team? Over the next year, the majority of the counselling team left; suffering symptoms of compassion fatigue, burnout or vicarious trauma. Several years later, I joined InterHealth Worldwide supporting numerous International NGOs. Having worked in the public and private sector, I was shocked to find that when I joined the charity sector, the lowest value was placed on staffs’ wellbeing. Organisations can involuntarily take advantage of the good nature of staff, who often describe their jobs as more than a job, a calling, or a way of life, by dictating unmanageable workloads or exposure to deployments without appropriate risk assessments. I setup InterHealth Worldwide’s trauma service supporting organisations through a crisis response. I noticed the ripple effect of trauma, from those directly impacted in the field, to those indirectly impacted in the office such as staff taking the call. I created support procedures and policies to provide safety and containment for all staff impacted, whether directly or indirectly. I collated data from each incident we supported and found that the risk of traumatic exposure to aid workers was increasing, including sexual violence and kidnapping and hostage taking. Only a couple of days ago, I posted an article entitled “Jidadists in northeast Nigeria execute five abducted humanitarian workers”. I have supported individuals who were impacted by the 7/7 bombings, Earthquake in Nepal, Ebola response, Syrian civil war, Search and Rescue refugee crisis, Westminster terrorist attack, London Bridge terrorist attack, Brussel bombings, anti-government protests in Istanbul, Juba attacks on aid workers, the Grenfell Tower fire, and Covid-19, to name a few. At FD Consultants we also offer support to organisations going through restructuring, bullying and harassment cases, death of staff, and conflicts within teams. Having worked in large organisations witnessing staffs’ mental health deteriorating due to the nature of their work, I wanted to create a high-quality specialist trauma service to support individuals to recover quickly. I became more and more frustrated with the quality of care offered and the lack of understanding in what is good quality trauma care. FD Consultants help guide organisations in how to support their staffs’ mental health, reducing risk of further damage, resulting in longer-term health issues and long-term sick leave. From my personal experience of suffering with PTSD, to working with thousands of individuals impacted by trauma, I am passionate about making sure people get access to high quality evidence-based trauma care. I strongly believe everyone can recover from stress, anxiety, burnout, vicarious trauma and PTSD with the appropriate help and support. Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. Encouraging the growing momentum around staff wellbeing in the humanitarian and human rights sectors19/7/2020 Throughout July FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. Arianna Rondos is a UKCP accredited psychotherapist. She specialises in refugees, trauma and psychological wellbeing of humanitarian and human rights workers. In addition to her psychological training she has an MA in Human Rights Law and has worked and lived internationally. Arianna offers psychological and research services for FD Consultants. “I found our session incredibly helpful! I had a post deployment assessment with another service provider back in 2015, and the person I spoke to then had almost no understanding of the type of work I did, and the unique stresses of the humanitarian environment. Your experience and deep engagement with the humanitarian sector is evident and really made the session meaningful to me.” (Humanitarian staff feedback) I joined FD Consultants at the start of 2019 with an academic and professional background in the fields of human rights, international development and gender-based violence (GBV) and with a clinical focus on refugees and trauma. Having lived internationally, in the Middle East, Balkans and in Europe during these years, I also had some knowledge of the aid sector field context. It was this experience which motivated me to broaden my clinical focus to include those who provide support to vulnerable communities and which led me to join FD Consultants as an Associate. I wanted to be involved in and to encourage the growing momentum around staff wellbeing in the humanitarian and human rights sectors. And, to acknowledge the value of my own struggle in appreciating how a desire to address the needs of the most vulnerable can lead one to neglect their own self-care. While my particular experience is not a prerequisite for this work, when significant in some way to the experience of the individual being supported, it can elicit what I have understood as a kind of ‘relief’. A relief, as some have described, in not ‘feeling like I have to spend most of the time explaining the way I live and work rather than what is actually going on for me’. At FD Consultants we attend to each of our clients in this way, with trauma specialist expertise and an understanding of the unique contexts in which humanitarian, human rights staff and first responders work. When meeting a person for the first time I will introduce myself with a little information about my background, which I provide as a way of letting them know that I can, in a way, speak the language of their work/life context. With each consultation I draw upon this experience and understanding of the sector to recognise and highlight the unique and meaningful ways a person is supporting their own resilience as well as where they might benefit from attending to themselves with more care. When working with trauma, I seek to convey that, while trained and experienced in this field, I am equally respectful of the uniqueness of their experience. Most recently, as part of the COVID-19 humanitarian response, FD Consultants’ Associates have been carrying out consultations with humanitarian aid staff preparing to deploy, the majority of whom are well seasoned in epidemic emergency settings. Much of their preparation and expectation, which I hear reflected in their calm yet adrenaline infused tone, is relevant to the COVID context. Some have already been on the frontlines at home, ‘facing shortages, infected colleagues, family members and an array of unknowns’, as one staff described. Others are prepared for these realities once on the ground. In support of this, our consultations focus on strengthening innate resilience. And, as I listen and inquire, I encourage the importance of self-care and boundaries by reinforcing responsibility for oneself, including taking breaks, not pushing beyond breaking point, as well as openly voicing concerns with the team leader. Given the global nature of the humanitarian and human rights sectors, our work often involves crossing cultures, ethnicities, religious affiliation, gender, sexuality and, when supporting young volunteers, generations. It also often involves crossing boarders, at the least, and, more often, continents, through video link or audio, and not always with an ideal internet connection. Yet, whether I am asking someone who has never undergone a psychological evaluated to share their experience or I am assessing someone following a traumatic incident, I am regularly struck by the openness with which I am met. And, how, whether speaking to national staff or deployed internationals, they will often describe a sense of personal responsibility, not only towards their work, but towards the wellbeing of their team’s, colleagues, organisations and, most of all, the communities they work in. With each of these interactions, I find myself both exponentially impressed by the work of humanitarian and human rights organisations as well as conscious of the work that still remains in destigmatising and normalising the inherent psychological stresses that accompany their efforts. FD Consultants appreciates the multifaceted nature of this responsibility and understands how organisations, which are increasingly committed to the wellbeing of their staff, can foster healthy working environments, which in turn support the communities they work with. By building relationships with these organisations, providing individual services to their staff and, by providing vital monitoring and evaluation, FD Consultants directly contributes to achieving the goals and objectives of the humanitarian sector through enhancing its duty of care policies. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. As part of the Coronavirus humanitarian response, FD Consultants have been carrying out consultations with humanitarian aid staff preparing to deploy. Having supported humanitarian staff prior to, during, as well as following deployments for many years and, in consideration of the unique and unprecedented circumstances of Coronavirus deployments, we have consolidated some reflections and considerations. Coronavirus Deployments The humanitarian sector recognises how Coronavirus responses will draw parallels to other familiar humanitarian scenes. In terms of deployments this might mean political violence or civil unrest, movement restrictions, curfews, being separated from loved ones with often unreliable internet and little time to communicate name a few. As well as, of course, the variety of related difficulties common to epidemic response, including stigmatization by the local population, managing PPE shortages and, carrying the responsibility for others’ lives. These are understood as a ‘part of the work’. Circumstances specific to Coronavirus deployments, on the other hand, are an evolving reality. Humanitarians are being asked to manage additional concerns. For example, as deployed staff you might be the vector of the virus to the vulnerable groups you are supporting. You may also be carrying concern for loved ones back home with you into a deployment aimed at addressing the same ‘danger’. Or, having to accept being ‘stuck’ for a period in your deployment country because of travel restrictions. Furthermore, as one staff member put it, “we’re very much on borrowed time.” And yet, there is the 14-day mandatory isolation upon arrival, which might include remaining isolated from fellow colleagues staying in the same location. Where, from the relative comfort of your accommodation, you will be supporting ‘remotely’ the crisis work going on within close proximity to you, knowing that local and other colleagues are ‘in the thick of it’. Possibly resulting in experiencing feelings of loneliness, guilt or frustration. With all this in mind, it is understandable, if not normal, to imagine that even the most well seasoned humanitarian will feel tested in ways their prior deployments have not. Coping strategies and resilience in Coronavirus deployments “You don’t know how long it’s going to take, how long you will have to be there to be sure things are up and running. You have to accept that before you go and let go of the ‘need to know”. This is how a humanitarian explained the way they manage some of the uncertainties faced in emergency deployments. At the time it struck me that this ‘letting go of the need to know’ was somehow both practical as well as self-compassionate. Coronavirus deployments not only carry the inherent stresses of emergency deployments but also unique personal and professional dimensions. Both practicality and self-compassion could go a long way towards encouraging resilience in such circumstances. As described by a number of staff, resilience is the ability to balance being highly adaptive to a fast-changing situation and set of needs with maintaining personal and professional boundaries so as not to burnout. Similarly, it is the ability to know when to say ‘I am out for now. I have to sleep, or rest, or be alone’, so you can remove yourself before you explode or make an unnecessary mistake. This inner voice that is letting you know it is time to take a break, however brief or inopportune, cannot be ignored. It is also about appreciating how teamwork is at the root of any successful deployment, as was repeated by all staff. This involves trusting, relying on, as well as supporting your team. Finding ways to communicate what you need to, at the same time letting go of moments of hostility or rudeness ‘till after deployment’. Coping, psychological wellbeing and, perceived sense of control When we are stressed it is often a product of overwhelm, of feeling out of control. In emergency deployments, particularly at present, where certain variables are entirely unknown, supporting our ‘perceived sense of control’ is key. Research into stress related coping styles has shown that ‘Engaging’ coping styles support our ‘perceived sense of control‘ and, in turn, our psychological wellbeing. Active confronting, for example, refers to directly and consciously facing the stressor, in a “hands on” way. Reassuring thoughts allow us to put things in perspective and to look for ways to acknowledge that, “it's not the end of the world.” Unsupportive coping styles, on the other hand, involve what are called disengagement strategies. When passively react, for example, we “wallow” in negativity, not really addressing the stressor. When we have a palliative reaction we disassociate from the stressor by letting the stressful event numb you. When avoiding we don’t address the problem directly but instead disengage from the situation and avert attention from it through escapism, wishful thinking, self-isolation, undue emotional restraint, and/or using drugs or alcohol. Sometimes we will shout at a colleague, which might be a sign we haven’t listened to the ‘switch’ telling us its time to take a break. All of these reactions are natural, even healthy, within limits. When they become the norm is when we need to reassess. How can FD Consultants support staff? FD Consultants, through their pre-deployment resilience consultations, psychological evaluations, mid and post deployment consultations, as well as trauma assessments and follow up trauma counselling, are well placed to support staff through all phases and experiences on deployment. Mid and post deployment consultations, as a means to ‘checking in’ on staff wellbeing, are recommended now, more so than ever, given the particularly intense and unprecedented circumstances in which staff are deploying. These provide an opportunity to talk through some of the deployment specific circumstances they may be facing, and how they can best cope. Get in touch with us today Author: Arianna Rondos (Associate, FD Consultants) |
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