Interview with Alessandra Pigni: Mindfulness for NGOs

Alessandra Is an independent psychologist and burnout specialist. As a former aid worker herself, she has a deep understanding of the psychological pressures and difficulties that come with the job. She facilitates mindfulness-based training for burnout and provides 1-1 Skype guidance and coaching to aid workers based around the world.

Mindfulness for NGOs

Mindfulness for NGOs is a staff care project founded by Alessandra Pigni and endorsed by The Oxford Mindfulness Centre (Oxford University) with the aim to build resilience and prevent burnout in aid workers.

Interview

People In Aid (PIA): How can organizations be better organized BEFORE they send people on assignments in terms of securing the ongoing mental health of their people while they are working in the field? i.e. What are the top three of four things they need to do?

Alessandra Pigni (AP): Before deployment organisations can do a few things to secure the ongoing mental health of their people while they are working in the field:

• Provide correct job descriptions and an appropriate briefing.
• Include burnout prevention and resilience training in the pre-departure preparation.
• Match aid workers with independent professionals who offer Skype guidance (coaching and counselling) for staff in the field.
• Ask aid workers what helps them in field situations and have a culturally sensitive and gender sensitive approach to staff care. ‘One size fits all’ does not work.

Let me explain these points in more detail.

It’s not uncommon for people to get to the field unclear about their job, with no briefing and no hand-over. This creates an unnecessary sense of uncertainty that fuels stress and anxiety. The aid worker is puzzled even before reaching the field.

Regarding preparation in the pre-deployment phase, burnout awareness and resilience training can help to make sure that people are familiar with the psychological risks and dangers of mental and emotional exhaustion. Aid workers need to be aware that burnout can be prevented through simple self-care practices. Burnout doesn’t have to come with the job of being an aid worker.

But good mental health in the field cannot be reduced to attending a workshop. Agencies need to cultivate an organisational culture that does not guilt-trip aid workers when they request support; where there is no shame or stigma attached to mental health, and where different needs are recognised (e.g. the ones of men and women, of local and international staff, of new and experienced professionals).

So for example, with a high rate of turnover following a first mission, supporting ‘new’ aid workers following the initial enthusiasm of a mission is vital. But with seasoned aid workers it’s important to keep their cynicism and emotional numbness in check - as these tend to be signs of burnout. With this group of professionals it’s more a question of “being there” through life transitions or decisions which may be related to continuing (if so, how) with a career that does not sit easily with having a family, raising children, having a home, etc.

Where organisations have a duty of care, I think that aid workers themselves play a role in looking after their own wellbeing, realising that we cannot meet other people’s needs effectively if we are not meeting our own.

Matching expats’ aid workers with an independent professional in the pre-deployment phase is a way to let the aid worker know from the start that help is at hand should they need it. It also means that a connection has been established when the aid worker is in a good place, and this makes it easier to seek support when the going gets tough.

Expats live and work in a foreign context, far from home, without their familiar social support. At times they need a ‘listening ear’, someone who can act as a sounding board, without the need for aid workers to label themselves as a recipient of ‘mental health care’. At times this may mean working on facilitating a personal or professional change – what we would call coaching. At other times it may be a confidential space where you can simply take off the mask and cry. A bit more like counseling. Personally, I call such process guidance, a helpful term that has neither the business flavour of coaching, nor the mental health taste of counselling, but may include both. Skype, with video-calls (where the bandwidth lets you do it!), is a great tool for that, and by planning for online sessions, organisations can provide excellent support in remote areas.

But talking is certainly not the only way to secure good mental health. HR managers need to ask aid workers HOW they want to be supported, LISTEN to their voice, ALLOW for R&R, and create a culturally-sensitive and gender-sensitive approach to staff care for both local and international employees.

To summarise I would say that a good preparation and ongoing support would include:

• an appropriate briefing, pre-deployment awareness training to build resilience and prevent burnout;
• matching aid workers with an independent professional (a skilled mentor) who can be contacted when the need for guidance arises in the field, even in times of ordinary operations.

At the recent HHR Conference in Amsterdam therapist Kate Nowlan shared with us this quote from Chekov: "Any idiot can deal with a crisis. It is this day-to-day living that wears you out". This is fundamentally true in aid work.

PIA: Much of your work is spent dealing with people after events – helping them deal with situations they have experienced. What are the most important things that organizations need to provide in terms of help AFTER traumatic events?

AP: Actually most of my work happens with aid workers who find themselves at a crossroads in their life or are burnt-out, often both. With between 40-50 percent of aid workers being at high risk of burnout I think that organisations need to invest more resources in its prevention and recovery. I work with groups providing mindfulness for stress and burnout training; plus, through Skype, I support aid workers who are going through important changes in their personal and professional life. People confronting existential issues around the meaning of their work, individuals who feel stuck, or more simply are unhappy in a mission and want to explore new ways to deal with work or life challenges, or tackle stressful team dynamics. Mindfulness and independent guidance are the tools that helped me through my missions when I worked as a field psychologist with MSF. This is what motivates me to bring them to other professionals who may be experiencing similar stressors, dilemmas, or challenges in isolated environments.

About post-event interventions, I don’t think that there is one single approach that can be implemented following critical incidents. Also, I believe that this idea that we have to get people to talk about the incident or their feelings following a traumatic event does not work for everyone. In fact, research shows that critical incident stress debriefing (CISD) may even, at times, be detrimental.

My take is that aid workers need to feel SAFE, SECURE and SEEN. Immediately after a traumatic event, it’s useful to have people who are familiar with Psychological First Aid because its focus is on the individuals’ needs for safety and security. My take is very much in line with the one of trauma expert Babette Rothschild (*) who says that common sense is a valuable therapeutic tool. So let’s never leave that behind and expect ‘experts’ to have solutions to what may simply be a normal reaction to a traumatic event. Staff support is about relations, and about honouring people’s resilience with presence.

It seems to me that there is an inflated focus on trauma and post-traumatic stress disorder (PTSD) when it comes to aid workers’ mental health. The reality is that following a traumatic event, most people find the resilience and the informal support to make it through, and only between 5-10 percent of humanitarian professionals develop PTSD. In fact, as research shows (**), post-traumatic growth (the ability to use traumatic events as a springboard for growth and greater wellbeing) may even be more common than post-traumatic stress. In times of crisis people stick together and team members are often able to support each other. Instead, when all seems normal it is often then that aid workers feel unsupported and isolated, with stress piling up, burnout creeping up and a world of expectations falling apart. All this with no-one caring because there is no big critical incident to justify an intervention.

In my opinion, instead of attaching mental health labels to people’s experiences, it’s helpful to see that at times aid workers are simply struggling. Their request for help (or lack of it) has more to do with life’s ups and downs, with feeling isolated, or with difficult team dynamics, than with psychological instability. In other words it is more existential than medical.

PIA: On the basis of your experience, do you think that aid and development organizations still don’t take enough care in preparing their people for what can often be hazardous assignments in the field?

AP: There is an amazing ongoing discussion on the professional network LinkedIn (Humanitarian Professionals Group and Devex Group) around the psychological preparation of aid workers. When I launched it over a year ago I wanted to hear from humanitarian and development professionals what their thoughts were on being ‘psychologically equipped’ for aid work, to corroborate my experience as a humanitarian psychologist with fresh input from the field.

That discussion has now become a forum with hundreds of comments by field and HQ staff, and they pretty much all say that there is no adequate psychological preparation for aid workers. I invite HR managers to read it, it’s very interesting, and it says what aid workers need.

Donors who worry about the rising costs of overheads need to see that without healthy and supported staff there are no good projects on the ground. The times of the ‘heroic’ volunteer who selflessly flies to the other side of the world to mend injustices and wrong-doings, I’m afraid is a myth. Humanitarian organisations are made up of people, and people have psychological needs, or more simply they have human needs: the need for relations and connections, the need to be seen, listened to and valued in an authentic, non-patronising way.

PIA: Going on from the last question, do you think that there should be some international standard psychological test or assessment that every aid worker should take before they are allowed to accept a field position?

AP: I’m not sure it’s a good idea to put people in a box through standardised assessments. We need sensitive and skilled professionals with excellent intuition who are able to raise red-flags during interviews. Plus we need a good, down-to-earth burnout awareness and resilience training. Once agencies have these in place, psychometric tests can provide an extra compass, but not become the ultimate tool to decide who goes to the field and who does not.

What is needed are not more standardised assessments and guidelines, but more genuine relations where ‘charity begins at home’, where the humanitarian values that we preach abroad are taken on board ‘at home’. Most of the issues that affect professionals in the field are human problems, which do not need to be medicalised. They have often to do with poor team dynamics or personal struggles. What needs to be re-established is the ‘human’ in humanitarian.

PIA: We hear a lot about a serious shortage of “people skills” in managers and supervisors. Do you think there needs to be much more emphasis on these types of skills and that this would have a positive effect on the experiences of people sent into difficult assignments? To put it simply, are we just too occupied reaching out and helping the needy of this world that we fail to adequately support those that are doing the helping?

AP: There is no doubt that managers receive little training to cultivate emotional intelligence. Emotional intelligence and self-awareness are key features of the skilled aid worker and have to do with being able to know when it’s time to listen, or to talk, to ask questions, or to be quiet, to engage empathically, or to challenge and have an open discussion. These are ‘people skills’, and yes they are essential, as much, as technical skills.

Aid workers learn what to do and what not to do if they are kidnapped, which is very important but a remote occurrence. At the same time they learn next to nothing about how to relate to difficult team dynamics and interpersonal conflicts, which are almost guaranteed during any mission.

Let me use an example I’m familiar with. When addressing problematic staff behaviour, many NGOs have a “warning” system in place. This may be a standard HR procedure, but in my opinion it is psychologically demeaning in both Western and non-Western cultures. Such warning system can become an easy way out, a way not to engage with problematic behaviour, or with issues that may need to be addressed within the office, and may require a healthy discussion. It breaks trust and dialogue between managers and the rest of the staff. Conflict resolution within an office requires people skills, not sanctions.

Again, it’s the ‘one-size fits all’ approach that doesn’t work. I don’t even think it has to do with being too occupied alleviating suffering. It seems to me that it has more to do with a lack of creativity – the ‘this is how we do things here’ mentality. Many aid workers point to this: there seem to be little space for thinking outside the box. That’s a shame, because there are many wonderful people who could really make excellent managers and leaders, if only they were given the tools and the space to do that.

PIA: Finally, Someone said that a timely hug or just a simple phrase like “well done” can mean a lot. Is that your view? Is it the simple things that we just need to get better at to improve everyone’s experiences?

AP: Small things done with genuine kindness and appreciation do mean a lot. The majority of aid workers are tired of the “macho culture” that still permeates many of humanitarian organisations. As explained in the previous question, I think there has to be space to be human in the field, a space to laugh and cry without being seen as silly or needy. There has to be a space where one can simply be (including being vulnerable), take stock and return to action with a ‘beginners’ mind’ - rather than a ‘I’ve seen all this before’ cynical-type of approach.

To summarise, no one who is asked, in non-emergency situations, to work around the clock can have a healthy field experience. Projects benefit from psychologically aware staff and good team dynamics. These are constructed through everyday presence, which has to do with informal support: drinking a cup of coffee together; allowing for human emotions to be around; sharing a lunch break; easily accessible guidance with independent professionals, (face-to-face when possible) or via Skype.

A closing personal reflection. Just this morning I received in the post a bulletin from an international NGO. It included a beautiful A3 page showing the amazing ‘blow-up, plug-and-play’ mobile hospital that the agency is able to have up and running within 48 hours of an emergency to operate round the clock.

But no one can be on their feet 24/7, even in an emergency without proper breaks and rest, right?

At the HHR Amsterdam conference Ted Lankester from Interhealth mentioned the need for ‘action and contemplation’ in aid work. When seeing this blow-up hospital brochure, I envisaged - next to the operating rooms - a space where aid workers can take stock, quietly sit for 5-10 minutes before returning to their job. I would have a ‘social area’ where aid workers can informally relax with colleagues, take a brief but proper lunch break, and a separate ‘quiet area’ for mini R&R (silent meditation, yoga, exercising, reading, etc.). I’m not talking about anything fancy or expensive, just a ‘breathing space tent’ where aid workers are allowed to come back to themselves before they give themselves to others again. But in my experience the reality is that the only ‘breathing space’ that most aid workers take in such situations is a cigarette break. For sure aid workers who manage to weave any self-care practices into their everyday life while in the field, tend not to burnout, are more effective and from my experience more ‘fun’ to work with.

Even in the midst of an emergency we need support and space to take stock and return to action with energy rather than exhaustion. All would benefit from it – ‘beneficiaries’, colleagues, family and of course the aid workers themselves – whereas unfortunately no one benefits from burnt-out professionals.

The impact that we have on others and the capacity ‘to make a difference’ stems from both technical skills – e.g. I know how to operate on a wounded child – as well as from ‘people skills’ – empathy, warmth, deep listening, authentic communication – and those depend very much on how we feel within ourselves. That’s why I say that ‘changing the world starts from within’.

• Babette Rothschild : A pioneer of traumatic stress recovery www.somatictraumatherapy.com/

** What doesn’t Kill, by psychologist Stephen Joseph : www.whatdoesntkillus.com/

Videos, bullets and more from Alessandra's presentation at the HHR Amsterdam Conference 2012.

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