At FD Consultants we specialise in supporting anyone who has been impacted by trauma through work or personal circumstances, whether directly or indirectly. If you work as an emergency first responder, for a mental health charity, or in the humanitarian sector then becoming trauma informed is crucial. To become trauma informed is also vital for lawyers, teachers, medical personnel, therapists, and anyone who works in a caring role and is supporting individuals who may be traumatised. Whether you have personally been impacted by a traumatic event or you are supporting a loved one through trauma, we need to increase our knowledge of the impact of trauma. We need to be able to recognise the signs of trauma, identify distressing triggers, understand the physiology and neuroscience of trauma, and be confident in having tools to support someone who is traumatised. We need to understand the ‘Many Faces of Trauma’, such as, developmental trauma, vicarious trauma, delayed trauma, inter-generational trauma, traumatic grief, PTSD and C-PTSD. At FD Consultants we have had many tech companies reaching out to us for support over the last year. The high-profile case where staff sued Facebook for suffering Post Traumatic Stress Disorder (PTSD), after viewing traumatic material online, has thrown into the limelight the impact of Vicarious trauma. Vicarious trauma, also sometimes referred to as secondary trauma, is the indirect impact of trauma, such as researching traumatic material, listening to stories, interviewing those who have been impacted by trauma, or exposure to traumatic material online. Does you work expose you to traumatic material? Are you experiencing trauma symptoms? Have you been personally impacted by a traumatic event? Do you want to help others who have been injured by the psychological impact of trauma? Do you want to become trauma informed? If you answer ‘yes’ to any of these questions, then sign up for our half day ‘Many Faces of Trauma’ workshops. We are offering three more dates this year: Thursday 7th October, Friday 19th Nov, Tuesday 14th Dec 2021 To book your place on one of the courses please click here: https://rebrand.ly/TraumaWorkshop “I have suffered from PTSD and this course has provided me with the tools and knowledge that I have been desperately in need of to support myself better.” We can also organise half day ‘Trauma Awareness’ workshops for organisation. If you feel your team or organisation would benefit from this workshop, then email us directly on: [email protected]. “This course is so interesting, and I now understand trauma so much more and feel confident in supporting traumatised individuals.”
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Training is an important factor in preparing and protecting staff and individuals when working in high stress environments. FD Consultants offers many training programmes, as shown below, and we can create bespoke training programmes as required.
Trauma Information Sheets
FD Consultants Individual support At FD Consultants we can help individuals recover from PTSD, vicarious trauma, stress, anxiety, depression and burnout. We are a network of accredited therapists. Organisational support For organisations looking for employee psychological support, FD Consultants are the 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. The image of an elephant, in its original habitat, roaming through the Kruger Park, South Africa, is imprinted on my mind today; watching the magnificent stillness, at sunset and sunrise, as the red blanket radiates over the landscape. I have also witnessed elephants in India during festival times, although equally magnificent creatures, this was a harder observation, as the elephants had large chains around their ankles and had become subdued to the loud bangs of celebration all around them. In Hinduism, Ganesha, one of the most worshipped Gods, is easily recognised by his elephant’s head. Ganesha is characterised as the remover of obstacles. The large elephant headed deity, removing that which is negative in its path.
When we are impacted by trauma, we may feel chained, restricted, fragmented, subdued, and penned in by unmoveable obstacles. There is a great deal of research now that shows when we recover from trauma, we can experience post traumatic growth. My book “Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Care” (Dunkley, 2018), is full of case studies of aid workers who have suffered acute stress, burnout or Post-Traumatic Stress Disorder (PTSD). The last chapter focuses on each and every one of these stories and describes a process of ‘post traumatic growth’, where many of these individuals have gone on to use their experiences to help others. My own story of post traumatic growth is described in my book, and perhaps is the main reason my work specialises in trauma care. I am able to sit in the most uncomfortable places and hold hope that each individual will recover. I strongly believe everyone can recover from trauma with specialist support. Unfortunately, there are many therapists that state they work with trauma, but are not specialists. Someone’s recovery of maybe six sessions, develops into years of talking therapy. Many of our associates at FD Consultants offer EMDR and TF-CBT trauma therapy (as recommended by WHO, APA and NICE). At FD Consultants we offer a half-day ‘Trauma and Vicarious Trauma Workshop’. Staff that are identified in ‘high risk’ roles, possibly through the location or intensity of their work, or the risk of being exposed to traumatic material, whether directly or indirectly, would benefit from this workshop. It is a more in-depth look at the neuroscience of trauma, physiology, symptoms and building resources, than our stress management workshop. There are many myths and misunderstanding about how to best treat individuals who are traumatised. There is also a great risk of re-traumatising someone who is suffering from trauma symptoms without the knowledge from this workshop. Therefore, this workshop is also helpful for managers supporting staff who may be suffering trauma or vicarious trauma, and staff who have been impacted by a critical incident. Over the last few years at FD Consultants we have supported staff who have experienced sexual violence, hostage and kidnapping, civil unrest, assault, bullying and harassment, road traffic accidents, natural disasters, death of colleagues through accident or suicide, and the impact of organisational restructuring. We have supported organisations’ whose staff have been impacted by the Ethiopian plane crash, conflict in Yemen and Syria, earthquakes in Indonesia, Australian bush fires, floods in India, the Persian Gulf crisis, further Ebola outbreaks, and the Myanmar Rohingya refugee crisis. But not only do we, as FD Consultants, recognise the direct impact of trauma, we also make sure organisations do not overlook the corrosive impact of vicarious trauma, sometimes known as secondary trauma. Research states that by listening to stories of trauma, we can start to be impacted by trauma symptoms, especially if we are empathic or intuitive, as our mirror neurones start to fire in the same way as the person telling us the story. Listening to the media or reading traumatic material can impact us vicariously. Organisations do not necessarily know what lies in someone’s past and whether they may have a deep-rooted trauma that can be triggered by the work they do. We have carried out psychological debriefings for staff who completed research on human rights issues, such as torture, false imprisonment, sexual violence or suicide. We support researchers, journalists, and legal staff. We have also helped frontline staff, such as reception staff, who may experience direct threat in the office, or indirect threat through social media or email. For one large international NGO (non-governmental organisation), we have started facilitating ‘threat communication’ workshops alongside security consultants, as we are finding this type of issue increasing. If you want to find out more about our workshops, please email [email protected]. If you are working in an environment where there is risk of being exposed to traumatic material, or you are managing staff that are at risk, please become trauma informed. Fiona Dunkley (Founder of FD Consultants) 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. What we see is a new type of war veteran, the international humanitarian worker, returning from the battlefields unable to escape the horrors there. It is obviously very important that aid organisations begin considering seriously the factors affecting their project personnel. Someone must be able to spot the danger signals at an early stage, and help exposed personnel in dealing with their situation (Smith et al, 1996). Relief workers today are faced with situations which generate more stress than straightforward natural disasters. This happens in a context in which the usual support mechanisms of family, partner or close friends are absent. Furthermore, the culture in the humanitarian community, which may be one of bravado and competition in emergency situations, does often not allow the space for discussing issues such as psychological stress. Despite mounting anecdotal evidence that stress and its consequences are key occupational health hazards, humanitarian agencies have not moved quickly enough to minimise the risks to the psychological well-being of their staff,. Some common problems Some of the common stress-related problems seen in relief workers include burnout, psychosomatic disorders, and risk-taking behaviour such as alcohol abuse. Unlike domestic rescue workers who are periodically exposed to short stressful events, relief workers may suffer exposure to chronic low levels of stress by, for example, residing in insecure environments for many years. It is in this setting that stress may be cumulative. Burnout is probably the most commonly used lay term associated with cumulative stress. It is a process that is usually gradual in onset. Symptoms can be grouped into five categories (Kahill, 1988):
Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are more formal diagnoses related to exposure to severe traumatic stressors such as a direct assault or abduction (primary traumatisation) or witnessing the death or abduction of a colleague (secondary traumatisation). The phenomenon of tertiary traumatisation is also increasingly recognised (Jensen, 1999). Examples include being witness to mass violence or listening to first-hand accounts of traumatised people. ASD appears relatively quickly after exposure to a particular stressor and, by definition, resolves within a month. It includes a spectrum of emotional reactions, cognitive changes such as confusion, and symptoms of mental and physical hyperactivity. PTSD symptoms appear from one month to three months after a given event. Symptoms usually involve flashbacks to the events and a state of being hyper-alert. Symptoms may become chronic and extremely debilitating. In their attempt to find a new internal equilibrium, relief workers may also respond to unresolved stress with more subtle behavioural changes. One such reaction has been termed “enmeshment” and is akin to survivor guilt with an over identification with the beneficiary population (Smith et al, 1996). This reaction may be more common in the younger, more idealistic relief worker. By contrast, avoidance reactions of distancing, withdrawal and denial may be more common among experienced personnel. Finally, relief workers may exhibit self-destructive behaviours such as working to the point of exhaustion, consuming excessive amounts of alcohol, or engaging in unprotected sexual encounters. Problems exacerbated by the humanitarian sector Many of these problems may be exacerbated by factors particular to the humanitarian sector. For example, relief workers do not usually benefit from being in a well-trained, tightly knit unit with a clear command structure. In addition, training and briefing, particularly with regard to psychological issues, is generally inadequate. This is particularly pertinent for those organisations which deploy a high proportion of first assignment volunteers. Third, aid workers are often called upon to perform duties outside their realm of professional competency and experience. Finally, there is the pressure when the drive to ensure the visibility of their own organisation may over-ride questions of the appropriateness or quality of interventions. Two other issues deserve mention because they are relatively modern sources of tension in the humanitarian sector. First, is the pressure of discovering that one’s internal mandate in terms of personal ethics and preferred approach does not match the mandate of a particular organisation. Second, is the changing culture of humanitarian work. Organisations are more self-critical than previously and are increasingly putting resources towards evaluating their activities. Inevitably external criticism, even if constructive, leads to a re-assessment of an individual’s perception of his/her own effectiveness. The latter is particularly true if individuals have an unrealistic expectation of what they may achieve under any given circumstance. Recommendations An individual has three levels of resources, personal, social and organisational, at his/her disposal with which to tackle demands. Organisations should seek to strengthen these resources wherever possible. The personal level: Selection and training are key areas where organisations could better support their personnel. In the past the key qualities organisations have looked for when selecting personnel are flexibility, maturity, adaptability, ability to work in a team and past experience in emergency situations (McCall & Salama, 1999). While experience is crucial, this must be tempered by the knowledge that stress can be cumulative, especially in the setting of aid workers going directly from one emergency to the next. Individuals who have a past psychiatric history including that of alcohol abuse or those with a recent significant life event such as a relationship break up should be regarded as being at higher risk of psychological distress. More effort needs to be made to ensure that an individual understands and is comfortable with the mandate of the organisation and has a realistic expectation of living conditions, security conditions, potential risks including to psychological health and what can be achieved in the circumstances. Some examples of best practice in this setting include being interviewed by the person directly responsible for the project by telephone or in person, and in-depth discussion of hypothetical field scenarios that illustrate some of the complex trade-offs inherent in humanitarian work. Studies in various settings have shown that untrained, poorly briefed staff suffer most from stress-related illness (Ursano & McCarroll, 1994). Briefing and debriefing should be mandatory and in person. It should cover an individual’s personal and emotional reaction to their work environment, not merely the programmatic or administrative issues encountered. A briefing and debriefing by a psychotherapist should represent the standard for all emergency assignments. Mental health professionals working in this role should themselves ideally have experience of humanitarian emergencies. Training courses should cover stress management techniques (types of stress, coping strategies, how to access help within the organisation), cross-cultural issues, team building/conflict resolution strategies, as well as the ethical frameworks and moral dilemmas of humanitarian relief. Courses should also help to prepare recruits for the task of adapting their professional skills to an environment which may demand a very different orientation. The social level: Organisations should be more willing to accommodate couples on assignment, particularly if both have relevant skills. Unless situations pose extreme risk, couples themselves should be given the autonomy to weigh the benefits and risks of the presence of an accompanying partner. Managers should consider flexibility in breaks so as to maximise, wherever possible, couples’ time together. It is also important that those responsible for recruiting understand the team dynamic in each particular field and attempt to match new recruits to a field that will potentially suit them. The organisational level: Formal policies on the prevention of stress in the humanitarian sector are frequently non-existent or incomplete and vary significantly from one organisation to the next (McCall & Salama, 1999). Strategies for improving briefing, training and debriefing need to take place in the context of organisations developing clear, written and comprehensive policies on the psychological health of their employees. Within the framework of institutional policies, mechanisms to support relief workers in the field need more detailed elaboration. A formal mentoring system for new personnel or the designation of a particular individual chosen by his peers in the field to act as the support person for that particular area are two examples of current practice. Policies on the use of critical incident stress debriefing (CISD) also need to be put in place. CISD may be a useful technique particularly in acutely traumatic events such as a line-of-duty death. Furthermore, organisations should come to a consensus on the most appropriate methods for psycho-social follow-up of employees so that they are able to determine what happens to their workers after leaving the organisation; the success with which they negotiate the difficult transition back into their former environments, as well as the proportion that suffer psychological distress. Anonymous cross-sectional surveys at regular intervals are one possibility. Finally, there must be a recognition of the effects on empathetic field managers of coping with the stress of numerous employees. In effect this is a form of tertiary traumatisation and they too must be able to recognise the symptoms of stress in themselves and call in re-enforcements if necessary. Peer support networks of regional managers often occur on an ad hoc basis but this could be made more formal. Conclusion Unfortunately, humanitarian emergencies are becoming more common. Concurrently the humanitarian sector is becoming larger and more professional, and we are seeing a new type of professional: the career relief worker. These environments, however, are not ordinary work places; they expose individuals and organisations to new dilemmas and new challenges. Staff turnover is high and burnout is common. Perhaps the crucial element in the achievement of the humanitarian goal today is the development of a stable and experienced workforce whose energies are effectively harnessed through more enlightened organisational policies. When seen in this light, the psychological support of relief workers is simply part of the employer’s duty and responsibility. It is not an optional extra. We’ve come a long way in our understanding of Post-Traumatic Stress Disorder (PTSD). From the early designation of “shell shock” for military veterans to transforming the label of “hysteria” to PTSD for survivors of rape, we know that trauma can have lasting physical and emotional effects on those who experience it. However, often we default to discussing only soldiers and victims of sexual violence when we talk about PTSD. These experiences are certainly among the leading causes, yet they aren’t the only type of trauma that result in PTSD. Let’s expand on how trauma of any kind changes us and how that impacts the way we think about PTSD. Looking at Big ‘T’ Trauma Trauma is generally categorised by what experts call big ‘T’ trauma or little ‘t’ trauma. Officially, PTSD diagnoses result after big ‘T’ trauma, events that anyone would consider extremely distressing. Combat and sexual violence certainly qualify, but so do major car accidents, plane crashes, and living through natural disasters. Following Hurricane Sandy in 2012, for example, a study that screened residents along the New Jersey coast found that 14.5 percent of adults were likely suffering from PTSD six months after the hurricane hit. Add to the list school shootings, terrorist attacks, residing in war zones; relational violence like domestic abuse, physical abuse, and emotional abuse; to the violence of incarceration and crime — PTSD-causing big ‘T’ trauma casts a wide net. Witnessing Trauma PTSD can also be caused by witnessing trauma happening to others or learning a loved one has experienced a traumatic event. According to a World Health Organisation survey of citizens in 21 countries, 10 percent of respondents reported witnessing violence (21.8 percent; the largest response in the survey) and trauma to a loved one (12.5 percent). Big ‘T’ Versus Little ‘t’ Trauma The causes above cover what the Diagnostic and Statistical Manual of Mental Health Disorders specifies in diagnosing PTSD: “Exposure to actual or threatened death, serious injury, or sexual violence” and witnessing “the event(s) as it occurred to others.” As researchers delve deeper into PTSD, they are finding that these qualifications may be limiting. We talked about big ‘T’ trauma, but there’s also that little ‘t’ trauma. Little ‘t’ traumas are classified as stressful events that happen to all of us at one point or another. Think more “personal” stressors, like job changes, messy breakups, unplanned major expenses, and the loss of a loved one. These instances, which seriously challenge our ability to cope, have traditionally been left out of the conversation about PTSD. “One of the most overlooked aspects of small ‘t’ traumas is their accumulated effect,” writes psychologist Elyssa Barbash in Psychology Today. “While one small ‘t’ trauma is unlikely to lead to significant distress, multiple compounded small ‘t’ traumas, particularly in a short span of time, are more likely to lead to an increase in distress and trouble with emotional functioning.” Expanding How We Approach PTSD Barbash stops short of saying that a collection of small ‘t’ traumas can cause PTSD but admits “it is possible that a person can develop some trauma response symptoms.” Psychotherapist Sara Staggs offers a similar perspective in her blog for Psych Central, pointing out that PTSD and stress reactions following trauma are tied not so much to the event itself but to the way our brain processes the information. “Then there is any other type of event which exceeds our capacity to cope, and can be stored as trauma,” Staggs said. “To some degree, it doesn’t matter what propels us into fight-flight-freeze mode, but only that the event was experienced and then stored that way.” How the Brain Stores Traumatic Memories We know that the brain stores traumatic memories differently than regular ones. These memories are so overwhelming our brain doesn’t process them completely the first time around. It can be described as the difference between putting your canned goods neatly away on the shelf versus shoving everything in a cabinet and slamming the door shut in a hurry. The latter is how the brain might handle traumatic information, which can lead to the tell-tale symptoms of PTSD: flashbacks and nightmares, isolation, dissociation, emotional detachment, heightened anxiety, and avoidance of trauma reminders, among other symptoms. What We Know About PTSD’s Development Additional research suggests there are many factors at play that determine who develops PTSD, since only an estimated 3.6 percent of the global population lives with PTSD in any given year. Not all of us who experience trauma will develop PTSD, even if we’ve lived through or witnessed the same exact experience. For example, we’re more susceptible when we’ve had a major trauma in the past. There may be a genetic predisposition to PTSD. Having limited social support following a stressful event also increases our risk for PTSD, as does experiencing multiple traumas at the same time. In time, how trauma is defined when diagnosing PTSD may change to incorporate a growing understanding of how we’re impacted by traumas large and small. Seeking Help for PTSD By expanding how we look at PTSD beyond just veterans and rape survivors, we can raise awareness that there are many traumatic experiences that can lead to PTSD. And when we do that, we reduce the stigma of reaching out for help when we need it. If you, or you know someone, who is struggling with PTSD of the after affects of a traumatic experience please do get in touch with us today. We are here to support you. |
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