In March, the International Rehabilitation Council for Torture Victims (IRCT) hosted a panel discussion called “Care for Caregivers,” about self-care for mental health and psychosocial support (MHPSS) practitioners who work with survivors of torture. Liyam Eloul, CVT clinical advisor for mental health, participated as one of the speakers, along with Sana Hamzeh, psychotherapist, Restart Center, Lebanon; Mechthild Wenk-Ansohn, independent trainer in supervision; and Carla Uriarte Chávarri, organizational psychologist, International Committee of the Red Cross.

Liyam spoke about staff wellbeing and the use of CVT’s Professional Quality of Life (ProQOL) as a monitoring tool, both at the individual level of self-care and at the organizational level of staff care.  “Effective self-care is at the heart of trauma-informed care,” Liyam said, “so the ability to self-reflect on personal wellbeing and then utilize effective practices for self-regulation is critical for MHPSS workers.” She noted that in parallel, a trauma-informed organization tracks staff wellbeing and employs policies that maximize protective factors in the workplace, to counter the inevitable risks faced in this work. 

Effective self-care is at the heart of trauma-informed care, so the ability to self-reflect on personal wellbeing and then utilize effective practices for self-regulation is critical for MHPSS workers.”

Liyam Eloul, clinical advisor for mental health

She described two key components of CVT’s clinical operations: emphasis on clinical supervision with a strong staff-care element, along with policies that support the use of regular staff self-care and team strengthening practices designed to maintain team health. 

She provided background with an example of the staff support system for CVT’s programs in Northern Ethiopia, a process which begins during onboarding of new clinicians. Psychoeducation is given about the impacts of trauma, compassion fatigue, compassion satisfaction and self-care, and then there are regular workshops on self-regulation and self-care techniques for clinical staff.

The teams have a staff-care committee that organizes monthly, half-day activities for team health. Liyam said, “For our teams working in remote areas, away from their families, team health is core to staff wellbeing,” so the dedicated time for teambuilding was essential. In addition, staff have access to regular group and individual staff support sessions with an in-person consultant from the region.

Liyam also spoke about ProQOL, a 30-item, self-reported measure of the positive and negative aspects of providing care, a tool that has been incorporated into many CVT’s clinical programs. The ProQOL tool, which is free and available in 28 languages, measures compassion satisfaction and fatigue, defining those as states where you feel fulfilled while acting with compassion for others, compared to a state of fatigue when acting with compassion feels overwhelming and draining.

She also spoke about the difference between burnout and vicarious trauma, commenting that the distinction is important because “burnout and vicarious trauma are elicited from different exposures to stress, and symptoms are better addressed with different self-care and staff support techniques.” She recommends addressing symptoms of burnout with coping skills that are energizing or help make a frame-shift between work and non-work environments, perhaps with exercise or social support. Shifting tasks, managing workloads and taking time off are also effective.

With vicarious trauma, Liyam recommends a focus on coping skills that target symptoms, such as grounding, breathing, mindfulness and visualization. “No one is born ready to work in high trauma fields,” Liyam said. “We need ongoing training and support to build those muscles, keep our baseline functioning high enough, keep building our own resilience.”

No one is born ready to work in high trauma fields. We need ongoing training and support to build those muscles, keep our baseline functioning high enough, keep building our own resilience.”

Liyam Eloul

IRCT VIDEO: Liyam speaks here about the differences between vicarious trauma and burnout, and what to do if you are experiencing these – they require different self-care and staff support techniques.

Coping with trauma is a continual challenge for MHPSS workers. Liyam noted that CVT’s work in Northern Ethiopia was impacted when armed conflict began in 2020, shifting both the clients we served and the ways in which staff were personally impacted. “Implicit boundaries which had previously protected the team from vicarious trauma were suddenly restricted,” Liyam said. “They were now serving their own population, and in some cases their own community members.”

Liyam and the team brought on an external staff support consultant and leaned on the long-standing and robust supervision system that was in place. She said, “Capacitating supervisors to address the new challenges that began coming up with the onset of the conflict (e.g., survivor’s guilt, ambiguous loss and complex grief, difficulty maintaining boundaries) became paramount and led to a series of supervision guidance notes to be used as resources, along with regular coaching calls with the clinical advisor.”

Liyam also discussed a second tool available from ProQOL, the ProQOL Health measure, which better fit the new situation for staff because of its expanded conceptualization of protective and vulnerability factors, which includes moral distress and perceived support. Moral distress occurs when workers must act in ways that are contrary to their personal and professional values, thereby undermining their sense of personal integrity and aspects of identity. Perceived support is defined as an individual’s experience of being cared for or loved, having a sense of being valued and needed by other people, and being part of a mutually supportive network.

Liyam closed her talk with three suggestions for reflection for MHPSS practitioners, noting that it’s important to “know your whys,” and keep a focus on the meaningful reasons for doing this work. For your own wellbeing, she suggests:

• Visualize a rewarding moment at your job in the last month.
• Visualize five people whose lives you’ve touched.
• Visualize three clients who have touched your life.

Resources

For more information on the ProQOL tool, visit www.proqol.org.

Click here for handouts on compassion satisfaction, compassion fatigue or other concepts discussed in this article, as well as handouts for useful self-care practices.

Click here for additional resources on staff wellbeing.

If you are interested in training on organizational approaches to staff wellbeing, please email [email protected].