Managing stress in Humanitarian Work
Self-care is a core principle of social work, and is critical for effective work with migrants and refugees. Yet, it is not universally practiced within humanitarian agencies serving these populations. Stress management requires responses at both individual and agency levels. Stress management is often conceptualized in three categories: what type of stress can be avoided, what type of stress can be accepted and what can be adjusted to decrease the psychological impact of stress. Aid workers accept the stress created by the humanitarian crisis environment they choose to work in. They can adapt, with the help of staff care plans such as counseling services and peer support services, to the stress created by their own potential histories of trauma and mental illness and the stress created by the workplace.
However, when the majority of staff are experiencing psychological distress due to acute stress, without a support plan, the stress reactions can create a toxic work environment. A review of stress management and staff care techniques among international aid agencies revealed that 74% of staff felt moderately or extremely stressed and the top five areas of stress included workload, ability to achieve success, working hours, status of employment contract, and feeling undervalued and/or unable to contribute to decision making (1). This is the type of stress that can be avoided.
The impact of psychological distress on the individual includes self-destructive behaviors, emotional dysregulation, and cynicism. Self-destructive behaviors such as alcoholism or illicit drug use can have an overt impact on the office environment. Emotional dysregulation and cynicism have a more covert impact on the office environment, leading to outbursts of anger and blame, changes that often happen subtly over time. Erikkson, et. al (2013), in their work with locally recruited staff in Jordan, recognized that managers can be five times more likely than non-managers to experience burnout (2). Burnout decreases team cohesion, and ongoing stress leads to a 50% decrease in effectiveness among aid workers (3).
Common reactions to acute stress
Acute stress can cause feelings of anger, frustration, grief, over- or under-identification with clients, as well as symptoms of depression, anxiety and PTSD (1,3, 4). In other words, it causes a person to feel miserable. When we feel miserable, we either internalize or externalize our behaviors. When we internalize, we may blame ourselves, become cynical or become self-criticizing. When we externalize we may easily erupt in anger or project the critical feelings we see in ourselves onto others. Whether we internalize our feelings or externalize them, those feelings generally impact the way we treat other people, thereby increasing the stress experienced by our colleagues.
Stress in the humanitarian workplace can come from many different places: an individual’s history with trauma, or mental illness; ongoing exposure to people who have been traumatized and are suffering; high risk work environments; and from interactions with managers and colleagues. And if it is not managed or contained, it can spread. Stress leading to burnout is more likely to come from the way managers and colleagues interact with each other.
Stress that can be avoided
Stress created by the dynamic that is created within an office environment can be avoided or mitigated with recognition and action.
Many people who choose humanitarian work as their profession have ‘type A’ personalities. They are perfectionistic and highly motivated. Humanitarians are people who expect to make a difference in the world through the work they do (4). The reality of the work and its limitations can cause cognitive discord, that is, workers thought they would make a difference and now feel that none of it matters. They may focus more strongly on the failures of the work than on its successes and internalize the failures as their own. This often causes feelings of inferiority and shame in humanitarian workers (3).
This type of stress can cause serious challenges for the agency. According to studies, it can impede recruitment and retention of good staff, it cuts effectiveness in half and reduces team cohesion (5). When dysfunction sets in, no matter how hard people work the quality of services delivered will suffer.
Typical signs of agency burnout, as identified by the UN Refugee Agency (UNHCR) include high turnover, clique formation, frequent conflicts, scapegoating, lack of initiative, increased sick leave, and lower output (4).
Once aid workers experience burnout or emotional distress, they may begin to treat their colleagues in a more abrupt way, causing stress for colleagues and accelerating burnout among the team.
Example 1
A manager is emotionally exhausted from years of work, constantly advocating for refugee clients. The limitations and challenges of the work begin to feel more personal. The manager begins to feel ineffective, and questions whether or not their efforts matter at all. She struggles with negative self-talk and begins to feel that everyone sees her as ineffective and inefficient. The manager responds inconsistently by either withdrawing from staff or interpreting questions from staff as a personal attack. After several months, staff in turn, begin taking these responses personally, begin to feel powerless in their work, and begin to feel emotionally exhausted themselves.
Example 2
A young aid worker, on their first mission, witnesses a child being abused in a camp. He makes a referral to the child protection actors, but it appears that nothing happens. The aid worker advocates to his manager for assistance, but the child remains in the abusive environment. The aid worker begins to feel that he is the only one advocating for the safety of the child. He becomes disillusioned with the work and no longer trusts his co-workers or other agencies. In response, he begins working in isolation from the team.
Stress that is accepted
Humanitarians accept the stress of the high-risk environment, and are often much more patient with their refugee clients than they are with each other. But beyond the high-risk environment, aid workers are also accepting to work with individuals who have experienced trauma. What they may not realize is that, hearing the stories of trauma experienced by others may trigger their own memories of trauma. This type of stress can impede judgment and reduce coping skills (6). It can also result in depression, anxiety, and burnout (7).
Example 1
A new aid worker who grew up with a father who was often abusive, becomes triggered by a gender-based violence case. The aid worker withdraws from the family at first, and then finds herself in a verbal confrontation with the abuser, causing concern for the safety of the worker and the family.
Example 2
A seasoned aid worker, in a management role, begins to feel targeted by staff and managers. Each response from a staff person or a manager is met with frustration and the belief that the aid worker’s professionalism and dedication to the work is being called into question. He has been working for a year without leave. He used to enjoy going to the gym, but hasn’t gone in nearly 8 months. In addition, although his family is seen as strong social support, he has neither visited nor called his family in nearly 2 months.
Ways for a program to adapt and manage stress
Readers may note, that this work is high stress, both in the office and in the field. Seasoned staff may be more vulnerable to burnout due to previous experiences depression, anxiety, PTSD, or trauma (7). New staff are vulnerable to burn-out due to inexperience and personal history. Everyone could use support. More and more agencies are recognizing the need to support their staff through counseling and peer support programs. A 2009 study saw the use of staff counselors increase by 15% in 6 years and 12% of staff had used a counselor in the previous six months (1).
Through the use of support programs that offer peer support or counseling, agencies have the opportunity to help not only those who seek counseling but the entire agency. In my experience, through programming and training around burn-out, aid workers who would be considered ‘non-traditional’ counseling clients, are also more likely to seek services as needed, once they become familiar with the service provider. Support programs raise awareness about burn-out and as people seek support, toxic behaviors can decrease.
Example 1
An aid agency recognizes high levels of burn out in their staff. They hire an international consultant to provide ongoing training and counseling. After 9 months the psychosocial program is well-established and continued implementation is conducted by a local staff person/psychologist.
Example 2
An agency creates a torture survivor program. They hire a consultant to assist in developing a program delivery model that includes attention to the workloads of staff and provides ongoing clinical supervision to staff along with ongoing training on subject matters specific to torture survivors. After 1 year, the program staff remain engaged and the program continues to provide quality services to survivors.
*examples are a composite of multiple humanitarian workers’ experiences, as reported to or witnessed by the author, in consulting roles as Mental Health Advisor and Staff Counselor.
** Kristen Guskovict is a Licensed Clinical Social Worker and the founder of Humanitarian Empathy & Refugee Trauma (HEART) of Aid Work. She specializes in work with refugees and refugee service providers. More information about her can be found at www.heartofaidwork.com
Bibliography
1. Curling, P., Simmons, K. (2010) Stress and staff support strategies for international aid work. Intervention. Vol 8 (2), pg. 93–105
2. McCormack, L., Joseph, S. (2012) Psychological growth in humanitarian aid personnel: reintegrating with family and community following exposure to war and genocide. Community Work and Family Vol. 16 (2), pg. 147–163
3. UNHCR (2001) Managing the stress of humanitarian emergencies. Staff Welfare Section. Division of Human Resource Management. HQ. Retrieved at: https://drc.ngo/media/2113528/unhcr-booklet-on-stress-management.pdf
4. Nilsson, S., Sjöberg, M., Kallenberg, K., Larsson, G. (2011) Moral stress in international humanitarian aid and rescue operations: A grounded theory study. Ethics & Behavior. Vol. 21 (1). Pg. 49–68
5. Sommers-Flanagan, R. (2007) Ethical considerations in crisis and humanitarian interventions. Ethics & Behavior. Vol 17 (2) pg. 187–202
6. Lopes Cardozo, B., Gotway Crawford, C., Eriksson, C., Zhu, J., Sabin, M., Ager, A., Foy, D., Snider, L., Scholted, W., Kaiser, R., Olff, M., Rijnen, B., Simon, W. (2012) Psychological distress, depression, anxiety, and burnout among international aid workers: A longitudinal study. Plos ONE Vol. 7 (9)
