Diana Conroy. Diana is a Social Worker who graduated from BRIEF's Diploma programme in 2015. Since then, she has worked in Afghanistan supporting humanitarians, she completed her MSc in Post-traumatic Stress Disorder, and is undertaking her PhD on the topic of secondary traumatic stress and trauma informed practice. Diana is currently based in Nairobi, working as Staff Counsellor for the United Nations World Food Programme, supporting around 550 staff in HQ and field offices across Kenya.
I was not long out of the BRIEF Diploma course when I bagged my first humanitarian role in 2016. Off I trotted to Afghanistan to support all the local and foreign staff that were based in the mission there run by an international governmental organisation (IGO). This was putting the model to the test – was it truly cross cultural? How would it work if (or rather when) there was a critical incident and/or people witnessed something traumatic or were hurt? Could SFBT cope with the challenges of a hardship environment where the risks and stakes were this high? There we were, living and working in a huge compound for weeks at a time before we had a break, often stuck at home for periods if there were security incidents and it was not safe leave, our personal protection kit and grab bags ready and waiting. Or if we did leave, we were trapped in cars in the Kabul traffic like sitting ducks, or worrying about Improvised Explosive Devices on a road mission or flying in tiny planes across the country…. Planes that had to do a spiral descent to avoid Rocket Propelled Grenades (RPG’s) that could be fired at us.
As a short-term therapy, it proved ideal for humanitarians as they are often in the mission for a short while before they are reassigned elsewhere, and it wasn’t long after my arrival that staff started approaching me for sessions to cope with the environment and the difficulties it presented. New arrivals in particular were frightened and unsettled; insomnia was common. I followed the BRIEF model, beginning with establishing rapport, then asking what ‘best hopes’ they had from our session together? A common response was ‘to feel less anxious’. As we know when establishing our contract, we need to ensure that it is realistic (something we could achieve by talking therapy) and positively framed (not a not). I regularly used Harvey Ratner’s ‘great instead’ to ask what was desired in place of anxiety, and a typical response was to feel more relaxed and confident, or to be dealing with the environment in a way that was ‘good for me’. This then led onto the preferred future, scaling and a compliment. All well and good, but what about those trickier cases?
Working in a mission is a different beast from your standard therapeutic role. For one, you have to be flexible, as people don’t make therapy appointments in the standard way – a lot just tend to wander into your office or start talking to you as you’re walking around the compound, and you suddenly find yourself slap bang in the middle of a session. Referrals also come from medical services, or managers send staff they are concerned about to your door. One such case was an employee who had recently returned from medical leave with a diagnosis of Post-traumatic Stress Disorder (PTSD).
Now, as we know, SFBT works to goals that are set by the client, so what was I to do with this case where all the professionals were telling me that the issue to be addressed was the PTSD? Well, the answer was of course to trust the client! That is one of the things that I love most about SFBT, that we keep the positive expectation that the client knows what’s good for them, and that people are far more capable and resourceful than professionals may imagine. There is some interesting evidence about client and worker expectations from the substance misuse field; researchers divided cases randomly into two piles – one where they told the worker that the client was really ready for change, the other where they were told the client was stuck and hopeless. Guess who did better despite those piles containing a mixed bag of cases?
The benefits of the SFBT approach for this client (and working with PTSD and trauma in general) are that it focuses on the here and now and future, so there was no risk of re-traumatisation by asking for the ‘story’. Naturally, the client arrived primed by dozens of professionals before me to tell me all about their problems. They looked surprised, then relieved when I explained the approach and that we didn’t need to understand or talk about a problem to solve it - they could move on anyway. They agreed this was ok and we could get down to business. Asked about their ‘best hopes’ and what they wanted from any talking therapy; their goal was not related to PTSD at all. In fact, they wanted to be more compassionate. They identified the difference this would make would be to be more patient, understanding, calmer, connected to their family, and tolerant of a difficult manager. Suffice to say, the client came back for a handful of follow up sessions and as well as their relationships, the PTSD symptoms improved. When I left a year later, they were doing well and ‘getting on with it’.
When critical incidents occurred (which they did with alarming frequency), I used SFBT to support staff, including one memorable one where I was on the radio to staff who were being shelled by RPG’s in a bunker at a field office. As well as talking about day-to-day issues such as family, interests etc to distract, I asked about resources, including what had got a client through difficult times, amplifying strengths and assets, and asking how they would know that they had come through this one well when they walked out of the bunker. As we know SFBT sees a crisis also as an opportunity for a client to come out of it stronger and more resilient. None of clients I supported in critical incidents ended up in medical with PTSD or other issues, continuing in the world, so I count these interventions as a success.
Since those early days in Afghanistan, I have worked with hundreds of clients across the globe, from most places and cultures you could think of. I use the model I learned on the BRIEF Diploma most of the time, supplementing it these days with psycho-educational knowledge about the nervous system, so clients have a good understanding of what is happening in their bodies as well as their minds. Currently, I’m based in Africa, again looking after national and international staff across a mission that encompasses a wide variety of environments, including insecure ones. My most recent field trip was to staff who work in an enormous refugee camp and feed 80,000 people a month. It is incredibly physically and emotionally demanding work. Coping questions are often helpful for staff in these situations, with ‘what keeps you going’ a favourite. Staff commonly cite their dedication to the work and values, and amplification of these can build strengths, resources and resilience. My work is an enormous privilege and adventure, and I for one am glad that I have SFBT as my go-to tool in my therapeutic box.
Diana Conroy
Nairobi
17th March 2024
