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Trauma and its aftermath

21 February 2013

Trauma is almost always a surprise. No matter how resilient we think we are and no matter how much field experience we have, there is a distinct possibility that we will one day be faced with an experience that we cannot cope with.

If they are lucky, they will have managers who are equipped to help them through the crisis phase and beyond. If they are not, they will find themselves struggling to get by on their own. Managers themselves may be nervous to respond, believing that all trauma requires a complex clinical intervention. But evidence is increasingly suggesting that the most effective responses are by no means the most complicated … and they can be learned.

What is the catalyst?

For some people, trauma is a one-off catastrophe; an assault, a bereavement, a natural disaster. It is an event or incident that overwhelms their capacity to cope, leaving them unable to access both the external and internal resources that they might normally use to manage their life and their work.

For others, trauma creeps up slowly. Long-term exposure to distressed beneficiaries combined with relentless travel and high-pressure deadlines can slowly erode their ability to withstand unexpected shocks. We’ve all heard of the “straw that breaks the camel’s back”, but for these people, even a small accident might open the floodgates to years of pent-up anxiety.

The different reactions to trauma

If people are left unsupported after a trauma, they can begin to feel out of control. This in turn can generate often unhelpful behaviours as they struggle to cope. On an individual level, that might mean isolating in an attempt to conserve energy and avoid anything that feels unpredictable. It might also mean turning to alcohol or pornography to soothe away feelings of fear and helplessness. Perhaps most troublingly in humanitarian circles, it can also drive people to return to traumatic environments again and again as a way of trying to master a situation that they feel they failed to conquer.

If traumatic experiences are left unaddressed on a group level, teams will also start behaving in potentially unhelpful ways. One of the first signs of trouble is a breakup into small factions and cliques as team members seek out a sense of protection and camaraderie. Another red flag is a dramatic increase in unnecessary activity, such as e-mails, meetings and travel. While this may all look like work, it can actually represent little more than a collective attempt to deny difficult feelings and substitute action for thought.

Supporting them to get back on their feet

All, however, is not lost. While many people may find themselves unable to cope temporarily, they will quickly regain those capacities if they are encouraged to access basic resources and solid emotional support. If a sense of safety can be promptly restored, they will often be able to adapt and move on.

Psychological First Aid (PFA) offers a basic model for providing this kind of support. It starts with helping providers ensure that survivors feel safe and secure. It then helps them talk to those who have been traumatised in a way that puts them back in touch with their own resources and their own support structures. Importantly, it also helps providers spot those who may require extra support as they find their feet.

And crucially, it helps those who plan to deliver PFA think constructively about their own vulnerabilities and the supports that they will require if they are truly to be of use to others.

PFA is not therapy and it’s not counselling. It’s an easy-to-learn set of guidelines that can help people support others appropriately in the aftermath of trauma. For managers, it could mean the difference between a team that can come together and deal constructively and compassionately with what’s happened and one that slowly but surely breaks apart.

InterHealth Author: Mark Snelling

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