关怀尼泊尔:灾难援救中对救援者的心理关怀

作者:春姑娘 2015-05-25


(作者:Mark B. Borg, Jr., Grant H. Brenner, Daniel Berry, RN 翻译:张晓丽 校对:思 隋双戈)


尼泊尔突发的地震灾情和正在进行的人道主义救援引起了全球的关注。据统计逾800万人受到此次地震影响。大量民众出于对余震的担心,逃离加德满都回到了自己的家乡,因为当地能够提供更好的灾后援助,但同时也对物资供应及输送造成了压力。

到目前为止,死亡人数已经超过了5000人(截止201553日,人数已增至7000+),还在持续统计中。虽然当前物资供应紧张(现在仍然是个问题),满足人们的基本需求是重中之重,但人们的心理和情绪危机却会持续很多年。联合本地和外来专家组成的心理干预小组试图帮助人们减轻这次事件的影响,找出那些深受困扰的人,让他们重建安全感和归属感,当然仍然有多其他的问题有待解决。

通过查阅大量文献和实地体验,Hobfall等人,2007年列出了大众心理创伤干预的五个基本要素。人们需要:

1.安全感

2.镇定

3.自我与社区效能

4.联接

5.希望

从“人际关系(relationship)”和“假性人际关系(irrelationship)”的角度我们该如何考虑呢?

“假性人际关系”是一种共用的心理防御系统,用于屏蔽真正的连接。这个专业术语对于看起如此明确的灾难响应的环境而言,特别是在救援者及机构完全是出于利他主义的动机的情况下,有什么相关呢?对灾难救护人员言,提供照料的动力被强烈激活从积极的方面来看,灾难中以一致的结构化支持为工作构架,救援人员可以最在很大程度上避免“假性人际关系”动力所造成的危害。

是,“假性人际关系”的风险因素影响着灾难心理健康,主要陷阱如下

1.让求助想象或置自己、他人于险境。

2.把自己想象成为一个无懈可击的英雄;

3.变得太自我牺牲,而忽略了自己的基本需求;

4.对同事或受灾的个体产生负面情绪(例如怨恨);

5.逐渐耗竭或发展为共疲劳;

6.激活过去的未处理的创伤。

这些危害,包括受其影响的行为和交流方式,都可理解为“假性人际关系”模式,许多援救者选择做这项工作的部分原因是他们的童年都有过一些英雄行为,很好的处理了他们自己重要照料者的心理焦虑。

好的方面是,灾害凸显出人性最好的一面。在随后的几个月的灾后快速干预中,援救者发挥了很大的作用。人们彼此照顾并且相互之间建立了亲密的关系,凸显出人性的关怀。他们会不顾自我安危去帮助别人,满足他人的需求,我们称之为“甜蜜点”。

了让灾后出现真正的人际关系,在共享的社会背景,援救组织应避免“假性人际关系”融入工作中,采取一定的措施确保援救工作在明确的界限范围内,以防止过度投入。这些措施包括工作小时数的限定,每天留出时间进行思考和处理,关注团体动力,缩短安排的整体,替换使用新的志愿者候补人员。还包括对于援救者所付出的努力和取得的成绩予以肯定;如果问题太难以处理,给予时间和空间寻求督导,以及营造一个团队成员之间平等,垂直领导中角色和职责明确,给予即兴发挥余地并尊重个人的能力和技能的良好、透明的交流氛围。

本文的英文原文及链接:

https://www.psychologytoday.com/blog/irrelationship/201504/care-nepal


Care for Nepal

Care for the Caretaker in Mass-Trauma Intervention

Post published by Mark B. Borg, Jr., Ph.D, Grant H. Brenner, MD, and Daniel Berry, RN,

MHA on Apr 29, 2015 in Irrelationship

The current ongoing humanitarian and natural disaster unfolding in Nepal has caught the world's eye. It is estimated that over 8 million souls have been affected. The mass exodus of people from Kathmandu, out offear of aftershocks and back into traditional homes in the countryside is a factor which will provide greater local support, but will also place a strain on resources as well as complicate aide delivery.

So far, the number of fatalities is passing 5000 (7000+ as of 5/03/2015), and still counting. While attending to basic needs is a key priority, especially with strained resources (and will remain an issue), the psychological and emotional impact will linger for many years to come. Interventions now combining local and outside expertise may help to mitigate the impact, identify people having more profound difficulty, and help to re-establish a sense of safety and community but there a many other repercussions that need to be addressed1.

Based on an extensive review of the literature, and on-the-ground experience, Hobfall et al. (2007) have listed the following Five Essential Elements for Mass Trauma Intervention as follows. People need:

1. A sense of safety

2. Calming

3. A sense of self- and community-efficacy

4. Connectedness

5. Hope

How can we think about this from the point of view of relationship and irrelationship?

Irrelationship is a shared defensive system that serves the purpose of shielding the participants from true connection. How might this be relevant for something as seemingly clear-cut as disaster response, where responders and organizations trying to help are acting from altruistic motives? Caregiving dynamics are strongly activated in disaster responders. On the positive side, with a solid support structure providing scaffolding for working in disaster, responders can largely avoid the hazards of irrelationship-based dynamics.

But there are irrelationship risk factors related to disaster mental health. Here are the key pitfalls:

1. Enacting rescuer fantasies and placing oneself and others in harm's way

2. Coming to see oneself as an invulnerable hero

3. Becoming too self-sacrificing and neglecting one's own basic needs

4. Developing negative feelings (resentment, for example) toward colleagues or disaster-stricken individuals

5. Becoming burned out or developing compassion-fatigue

6. Activation of one's own unprocessed past traumas

These pitfalls—as well as the behaviors and patterns of interaction that they influence—can be understood as irrelationship dynamics, and many disaster-responders have chosen to do this work partially due to childhood experiences of having to take heroic measures to manage the anxiety of their own key caregivers.

On the brighter side, disasters bring out the best in human nature. In the immediate aftermath of a disaster, and in the months that follow, the majority of responders shine. The best side of human caregiving is expressed, and people make deep and intimate connections with one another and the people they help. This is the so-called ‘sweet spot’ where people set aside their own unhealthy needs in balanced deference to the needs of others, when the demand for help is appropriate and justified.

The chances of this kind of real relationship taking place post-disaster, in the context of shared community, is heightened when the organizations sending people have it build into their operations to ensure that there are definitive boundaries put in place to prevent over-engagement. They include limiting the number of hours worked, to setting aside time each day for reflection and processing, attending to team dynamics, shortening the duration of deployments and replacing personnel with fresh volunteers. They also address giving appropriate recognition for effort and accomplishment, setting aside a safe space and room to seek consultation if things get too difficult physically and/or emotionally, and establishing a culture of tactfully transparent communication both horizontally among team members, and vertically with leadership where roles and responsibilities are clearly defined, with room for improvisation and respect for individual capacities and skills.

References

Hobfoll, S. E.; Watson, P.; Bell, C. C., Bryant, R. A.; Brymer, M. J.; Friedman, M. J.; Friedman, M.; Berthold, P.R. ; Gersons, J.; de Jong, T. V.; Layne, C. M.; Maguen, S.; Neria, Y.; Norwood, A. E.; Pynoos, R. S.; Reissman, D.; Ruzek, J. I.; Shalev, A. Y.; Solomon, Z.; Steinberg, A. M., & Ursano, R. J. (2007). Five Essential elements of immediate and mid–term mass trauma intervention: Empirical evidence, Psychiatry, 70,283-315.

(Source:Psychology Tody )

(编辑:林俊锋)

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