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09 Sep 2022

Interview with a Ukrainian psychologist: Trauma can last decades

Liudmyla Baletska is a psychologist from an academic and non-governmental environment. She works with children with trauma and specializes on cognitive behavioral therapy and individual counseling. Currently, within the organization People in Need Slovakia runs the Psychosocial Assistance program in Ukraine. The program aims to improve psychosocial well-being, resilience and the ability to alleviate human suffering among displaced and other war-affected people in Ukraine. Liudmyla answered some of the most important questions about Psychosocial Assistance in Ukraine.
Ukrainian psychologist Liudmyla Baletska
What are the main goals of the Psychosocial Assistance program? First, to help the people of Ukraine recover and fix their lives. It belongs to psychosocial support, which also includes social assistance. Second, restore a sense of security. Those are two key goals that can be characterized very generally, in more detail we have other goals that we want to achieve within each micro-project. How long has this program been operating in Ukraine? The program started in June and was fully launched in July, when it changed from plans written on paper to direct work with people. How does the therapy work? Therapy is most effective when it is a set of measures. It is a whole system that must be available in sufficient quality to anyone who needs help. According to global recommendations, psychological services can be provided at the community level and at the family support level. This may include psychological education and the creation of child-friendly safe spaces and similar measures. Another level of care includes targeted psychological support for people with some emotional problems. In order to cope with stressful situations, psychological counseling is important for them, both individually and in groups, so that they can learn to cope with them on their own and recover. At the highest level is the clinical-psychological care that people with mental disorders need. In these cases, psychotherapy as well as the advice of a psychiatrist or other doctors are applicable. Do you have a procedure in place to provide psychosocial assistance? The program is implemented in three stages. In the first we launch volunteer teams in communities, in the second we set up mobile teams, each with two psychologists and two social workers. It works in such a way that the mobile team covers one rayon (district) and is dedicated to three communities. In reality, it looks like this: a mobile team arrives once a week to provide direct psychological support in the form of counseling, group work and psychological education. For now, social workers are identifying the needs of each household and collecting information so that they can redirect and help in the right direction, be it humanitarian, material or through counseling and recommendations from other bodies that provide information.
Experts are also assisted by volunteers
Does this mean that you help individuals overcome trauma or give them their own space to deal with unpleasant experiences? If necessary, we approach each family, their needs in the community and the individual very specifically. But it is very important to ensure that this help does not interfere with a person’s natural ability to recover from any trauma. After all, each person has their own natural immunity to trauma, their own strength and way of recovering from a traumatic experience. We try not to block this immunity and not to provide help “by force”, but to help those who really need it. Who is part of the professional team? Since 2014, we have had an experienced supervisor in Ukraine – a person working directly with psychologists who provide psychological support. It is important to note that the team already has 8 years of experience working with people marked by trauma. We know how to work with people who have survived war, shelling, gender-based violence, torture and much more. If we see that a person has panic attacks, depression and other difficulties, we redirect him to a narrow-profile specialist with correspondingly greater experience. What kinds of traumas do people come with? This is such a wide range that it is appropriate to take a small step back and look at the issue from an individual as well as a national perspective. On the one hand, we can already list all types of trauma, but on the other hand, the war continues, the traumatic events are not over yet, and the intense stress continues.
Volunteers must first undergo training
To what extent does the war traumatize people living in Ukraine? War is a destructive phenomenon. It affected some people to a greater extent, others to a lesser extent. It affects all Ukrainian men and women, even those who are outside the country. At the moment, we cannot estimate exactly how many people it has affected. I think we can’t even predict the full extent of it because we’re talking about problems that we’re going to have for at least the next forty to fifty years if we think broadly and take into account the traumatic experiences of previous generations, such as World War II, famine and other genocides, which Ukrainians experienced. That is why we cannot accurately assess the extent of the problems, but children and adults, and not only those of Ukrainian origin, will be affected by the war. Can people deal with trauma on their own or is the presence of experts necessary? During the six months of the war, the process of recovery began for Ukrainian men and women. Most of them are looking for ways to recover on their own.
If I can speak for all Ukrainians, I think we are just beginning to recover from the six months of terror that the whole of Ukraine was in. And only now are we beginning to realize the extent of the trauma.
This allows us to understand how trauma comprehensively affects areas of human life. In the individual sphere, we most often encounter trauma related to a disturbed sense of security, the ability to control one’s life and the events that take place in it, as well as frequent and sudden encounters with the death of relatives, close friends, and others. In technical parlance, it looks like cases of PTSD, post-traumatic stress disorder, wartime gender-based violence trauma, and bereavement trauma. Why is therapy important? And what can be the consequences of such trauma? It is worth noting that not all people need therapy, but everyone needs care. Here we can mention the classic psychological pyramid of care, from basic support to specialized therapy. In general, the most important point of psychological assistance at the moment is to help Ukrainians to recover and rebuild their lives, to give them a sense of support and to remind them that no one is alone in the war and that it will end sooner or later. A very important part of therapy are regular meetings, activities for children and daily artistic and sports activities.
Professional help is also addressed to children
How long is the process of recovery? Recovery does not happen immediately, but I assure you that long-term work with children brings results. They begin to create a daily routine, which is essential for children, because the routine “grounds” them, calms them down and makes them feel safe. They wake up every day knowing that the same adults are waiting for them, they have a simple plan for the whole week and their opinion is respected. Such a return to a sense of security is a basic attribute that can be considered from a psycho-emotional level as an important building block for building a healthy sense of security in children in the future as well.
Having a responsible person in your life who comes to you every day is very important.
If we talk about the emotional context and the positive contribution, there are people in the lives of these children that they can rely on – volunteers, thanks to which the children manage to get to know someone before starting school. In fact, this is how a person integrates into society: he gets to know a small group of people, then a larger one. First he meets two or three other children, later he goes to school and there he expands his circle of acquaintances, which later expands even more. Does working with children somehow affect their mothers? At present, children are mainly raised by mothers who are the sole breadwinners of the family and who have to go to work. We are talking about both local residents and internally displaced persons. Thanks to the program, women have one to four hours free for themselves, for work and free time, which is very important. Sometimes it is the most important thing that every mother needs in general. That’s why this bonus within the program is great.
Routine is important for children
Can psychosocial help mitigate catastrophic consequences? A traumatic event brings with it many different reactions and ways of coping with the consequences of such an event. In cases where trauma is involved, therapy is vital. It acts as a foundation for suicidal thoughts, helps avoid negative coping strategies such as alcohol and drug use, and helps to “train the muscles of resilience.” When it comes to trauma in children, it also works to prevent early childhood deaths. How long does it take for a person to recover from trauma? It depends on many factors: the subjective experience of the person, the strength of the traumatic event, the speed of providing the first crisis psychological aid, whether the person is in a safe place and the very types of interventions available to the psychologist or psychotherapist. However, it should be remembered that modern methods of psychological intervention are aimed at short-term support. These include, for example, the Common Elements Treatment Approach (CETA – based on evidence-based treatment for depression, anxiety, substance use, trauma and stress-related disorders); trauma-focused cognitive-behavioral therapy (TF-CBT); behavioral activation (BA) and others. All are set up for eight to twelve meetings between client and advisor.