How to wisely help refugees from Ukraine? Psychologist: a man in crisis can be compared to a paper handkerchief

The outbreak of war, no matter how we prepare for it, is always a huge shock. The Ukrainians, and even, though to a much lesser extent, us Poles are experiencing it now. The heart reflex tells us to help, although we do not always act as planned. We have many questions and doubts, because for most of us this is a new situation. We asked for her analysis from a psychologist. Marta Boczkowska claims that although psychological help is not the most necessary now, she gives the rules to be followed in order to carry it effectively.

1. It often seems that a quick intervention of a psychologist is needed because someone is behaving strangely, but these are just normal reactions to an abnormal situation – says psychologist Marta Boczkowska
2. The first basic thing that these people need is security – emphasizes Boczkowska
3. The feeling of security begins with physiology, which is why it is important, for example, to use the station’s toilet
4. – A glass of water symbolizes our help. If we flood with the help of a man who is flaccid like a handkerchief, absorbent, but still has a certain strength, we can harm him – explains the expert
5. You can follow the situation in Ukraine by watching our live coverage
6. More information can be found on the Onet homepage

– I believe that we are needed in many places, where we are either absent or too few – begins Marta Boczkowska, specialist in clinical psychology and crisis intervention from the SWPS University and IP PAN. – However, I think that most of our guests from Ukraine at the moment need nutritious soup and warm clothes more than a psychologist.

In an abnormal situation, any reaction is normal

It turns out that mental disorders resulting from a trauma or an extremely stressful event such as warfare, catastrophes, accidents, assault, rape, etc. occur relatively rarely.

Research shows that PTSD, or post-traumatic stress disorder, affects from 2 to a maximum of 16 percent. people, depending on the type and intensity of traumatic stimuli. While these 16 percent. are people who have experienced attacks or terrorism, so this group may include people affected by the war in Ukraine.

Those who have experienced other crises relatively recently, suffered somatic diseases or struggled with diseases and mental disorders are particularly vulnerable. In them, clinical symptoms of PTSD may appear relatively quickly, and it may be difficult for them to regain balance.

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It should be noted, however, that humans as a species have a natural ability to regain mental balance and regeneration, and the fact that we are able to recover from a crisis is our individual feature. Ba! There are many people among us who can recover from a crisis situation stronger.

– I work with patients from Ukraine and conversations with them make me realize that not all of them have experienced trauma – says Marta. – Many managed to escape at the beginning of the war. For them, the crisis was a difficult journey, but they had not heard the blasts yet, had not seen the bombing. On the other hand, people who have come to us in recent days have already experienced war traumas and they are potentially more exposed to PTSD. However, I emphasize that the majority of society is returning to equilibrium and this is an optimistic prognosis.

Currently, our dominant experience is shock, that is, the first response to a crisis. This is a universal experience, we Poles are also in shock. Of course, our neighbors experience shock more intensely, which is why psychologists emphasize that any of their reactions should be treated as normal, because the current situation is abnormal.

PTSD develops as a result of the trauma, but not immediately, it takes at least 8 weeks. All the reactions we see now in refugees are the acute stress response – ASD.

Therefore, it is most important that these people have the opportunity to collect their thoughts on their own and use their support network in the form of their loved ones. Too early help in the form of psychotherapy is giving a fish instead of a fishing rod, because it takes away independence.

Many years of research conducted by American psychologists in a group of helpers, e.g. firefighters, policemen, but also in survivors after the attack on the World Trade Center say that focusing on emotions and reacting to them in a group are not only ineffective, but also very harmful, because they can cause PTSD.

– We often think that a quick intervention of a psychologist is needed because someone cries terribly or laughs strangely, or does not respond readily to the proposed help, but these are the normal reactions to an abnormal situation – explains the psychologist.

To illustrate the situation of refugees, Marta compares a man in crisis to a paper handkerchief. Such a person is flaccid.

– If we take a glass of water and pour it on a handkerchief, it will soften and fall apart – he says. – A glass of water symbolizes our help. If we flood with the help of a man who is flaccid like a handkerchief, absorbent, but still has a certain strength, we can harm him. It is known that the heart reflex is rarely thought out, but it would be best if our help was planned. It should not be too intense, but rather targeted and dosed. Going back to the handkerchief and water comparison, that would be a speckle. Then the handkerchief absorbs, but does not disintegrate.

When we translate the words of a specialist into our reality, it turns out that refugees do not need the herds of psychologists waiting for them at the stations. They have just had a long and tiring journey and they need to organize their minds, take care of their sense of security and basic needs. In such a situation, it will be beneficial to reduce the stimuli. On the other hand, volunteers who will take care of meals, warm clothes or cleaning products will help in securing the basic needs.

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The feeling of security begins with physiology, hence such support is invaluable, for example, when a volunteer pays for the use of the station toilet. Giving refugees time to organize their thoughts does not mean, of course, that they are left to themselves. We should be there, ready to help, but a psychologist or psychiatrist is to act only when clinical symptoms or disorders appear.

Accompany carefully and be ready to help

We have two types of social support. The first is perceived support, the second is received support. The first is the feeling that I have a few people around to help if I need to. Translating this into the situation of refugees, the point is to make them feel that when it is necessary, there will be people, officials and specialists among us who will help them.

It is also not about doing something for the person in need, but accompanying them and shaking hands with them if they give a signal. The second type of social support is providing specific material, informational and emotional help.

– The basis, when it comes to psychological needs, is to give the sign: I am available – says Marta Boczkowska. – I do not come with a crisis intervention without an invitation, I do not involve in a support group or group reaction, which is forbidden. Interactions such as defusing (i.e. psychological help, leading to the relief of strong emotions and tensions caused by participation in particularly dramatic events – ed.) And debriefing (a psychologist meeting with participants of a traumatic event to discuss the impressions and reactions related to this event – ed.) are banned by the WHO. Meanwhile, I see many advertisements that psychologists are sought to conduct such activities with refugees. It is worth remembering especially employers who are massively looking for psychologists to support their employees from Ukraine.

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It is a myth that a psychologist is indispensable right away. These people need normal human contact, they need food, drink, shelter, work. Only in the event that the symptoms of severe stress persist, preventing you from functioning, you should think about a psychologist.

Great guidelines for helpers are provided by the publication of prof. Stevan Hobfoll and Dr. Patricia Watson.

They made a very thorough review of the world literature on the psychological influences that help in crisis and traumatic situations, but also those that can be harmful. Their advice should be used not only by specialists, but also by anyone willing to help. They distinguished five basic steps of psychological first aid in situations of natural disasters, catastrophes and wars. Here are their conclusions:

1. Promote a sense of security. It is about ensuring that your basic needs are met. Showing readiness to provide support and, most importantly, showing that there are places in the world where life is still normal. Security is also a protection against bad news, gossip and stereotypes. This is important in the context of fake news – if we want to help, don’t spread it.

2. Promote sedation. The best way to calm down is the normalization of symptoms, that is, showing understanding to all difficult and unexpected emotions.

3. Promote community self-esteem and effectiveness. There are many activities here, they are aimed at building self-governance and self-sufficiency of refugees. It may be organizing rallies, meetings or religious rituals, or organizing work. Nothing helped fishermen hit by the tsunami more than having them rebuild their boats so that they could return to their activities.

4. Promote connectivity. It is about enabling refugees to contact their relatives, families, but also people in a similar situation, so that they create supportive communities, so that they can exchange information support: “Where will I get my PESEL number, where I can eat well, where to send my child to a nursery” . The worst thing about trauma is loneliness, and the exchange of simple information, although it is not psychotherapy, is therapeutic.

5. Promote hope. Of course, anyone can help, but from the point of view of psychologists, it would be useful to set up crisis teams, e.g. at the level of provinces or specific organizations, to delegate individual tasks. Support hospitals by employing clinical psychologists so that they can support traumatized people. Social media is wonderful, communicates information quickly, but as a result, people in need often only get one kind of help because the writers have not thought about the others.

1. Read: Do you accept refugees from Ukraine? Some important tips on how to take care of their health

– The first basic thing these people need is security – emphasizes Marta Boczkowska – and safety is associated with law, order and normality. So if I leave a country where it is abnormal, because there is a war, it is normal that I can go to a place where there is peace, nothing unusual is happening at the station, there are meals, and life goes on as normal. This normalizes and even alleviates the crisis. Also, do not expect all refugees to respond to our help with a smile and words of gratitude. They have the right to react differently because they have just experienced something terrible.

First school for the child

When asked if psychologists should start working with refugee children, Marta replies that the situation here is even more difficult than with adults. As a rule, the psychologist should work primarily with parents. Give them tools so that they, as the closest to the child, will help. It is not the psychologist who will live with the child and build a life with him, but the parent. War does not change this situation. Your child will not feel better than just talking to a psychologist.

– I saw statements in social media that refugee children do not need school now – says Marta Boczkowska. – Such thinking is harmful. What really helps in the crisis? Order. People are looking for normality, and the opportunity to continue learning is to show that the world can still be a friendly place. These people came to Poland for the normality they had lost. Let us not treat them as victims, let us not incapacitate them, because we harm them in this way. Let them take advantage of being in a country where there is no war. This is not the time for psychotherapy, it is the time for wise social support that each of us can give.

Ms Marta gives the example of a child from Ukraine, whose relatives, one day after coming to Poland, decided to seek a psychological consultation for him. The family said something was wrong with him because they weren’t enjoying the LEGO bricks or the trip to the zoo. She also does not want to watch fairy tales and does not even reach for sweets. Based on these observations, the adults concluded that the 8-year-old boy definitely had PTSD. Meanwhile, he had too much stimulus.

– You have to keep common sense in everything, including helping – says the psychologist. – You can’t make up for the bombing with a trip to the zoo. Here you need peace and quiet. When a child is not eating, refusing to talk, it may just need a few days to get used to the unfamiliar surroundings. Adults in new places are also not always open and talkative. Sometimes, instead of a psychologist, you need to contact a doctor, because the lack of appetite does not have to result from post-traumatic disorders, but, for example, from the fact that after a 14-hour journey by trains, the digestive system may have become disturbed or Polish food does not taste quite good. The problem arises if the baby does not eat for a long time.

If children, e.g. at school, and adults at work, undergo regular stress management courses, this would be the best prevention. A psychologist is not a wizard, he will not charm reality to make people feel better. Psychology is not needed when it looks nice on the strip on TV, but much, much sooner.

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