Care for the Caretaker in Mass-Trauma Intervention
Post published byMark B. Borg, Jr., Ph.D, Grant H. Brenner, MD, and Daniel Berry, RN,
MHAon Apr 29, 2015 inIrrelationship
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 offearof 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 followingFive Essential Elements for Mass Trauma Intervention as follows. People need:
1. A sense of safety
3. A sense of self- and community-efficacy
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 fromaltruisticmotives?Caregivingdynamics 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 mentalhealth. Here are the key pitfalls:
1. Enacting rescuerfantasiesand 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
6. Activation of one's own unprocessed pasttraumas
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 tochildhoodexperiences of having to take heroic measures to manage theanxietyof their own key caregivers.
On the brighter side, disasters bring out the best in humannature. 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 withleadershipwhere roles and responsibilities are clearly defined, with room for improvisation and respect for individual capacities and skills.
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.