Grinko_War related trauma_Anna's Case IAIP

Clinical Case presentation

1. WAR RELATED TRAUMA
Anna’s Case
Natalia Grinko MD, PhD
Ukrainian Catholic University
06/07/2024

2. Background
01
2007 - MD, Bukovinian
State Medical University
02
2009 - Residency in medical
psychology, BSMU
03
2015 - Certificate in
psychotherapy (Adlerian
approach)
04
2020 - PhD, Kharkiv
Medical Academy of Post-
Graduate Education
05
2022 - Associate professor
at Ukrainian Catholic
University, Lviv

5. Reasons for presenting this case - Anna*
•Client whose presentation featured
war related trauma
•Demonstrates the importance of
telecounselling
•Highlights the need to make meaning
of events in period of uncertainty
•Collective trauma representation?

6. refers to the psychological reactions to a traumatic event
that affect an entire society; it does not merely reflect an
historical fact, the recollection of a terrible event that
happened to a group of people.
It suggests that the tragedy is represented in the
collective memory of the group, and like all forms of
memory it comprises not only a reproduction of the
events, but also an ongoing reconstruction of the trauma
in an attempt to make sense of it.
Collective memory of trauma is different from individual
memory because collective memory persists beyond the
lives of the direct survivors of the events, and is
remembered by group members that may be far
removed from the traumatic events in time and space.
Collective trauma

7. Anna 36 yo, female, Ukrainian
Religion: Christian
Visa status: Refugee in Ireland, near Dublin
Education & employment: MD, child and adolescent
neurologist at Regional Public Hospital
Referral information: online app “ Mental Help”,
primary reasons anxiety and helplessness
Intervention information: 12 sessions (6 sessions/
once a week, 6 sessions/ once per 2 weeks)
Background information

8. •Anna was born and lived in Mykholayv, East of
Ukraine.
•Female, tall and good-looking.
•She was typically well-groomed and dressed in
casual clothing.
•Always on time or even earlier, and never
missed a session.
• Committed to therapy, and sessions were
scheduled by her, same date and time every
week.
•During sessions always make some notes, can
have questions and insights on the next session
or visit.
•She knows a lot about mental health and
psychiatry.

9. PRESENTING PROBLEMS
•Anxiety and feeling of helplessness
•Feeling of detachment, social isolation
•Severe sleep difficulties attributed to headache and anxiety
•Problems with family relationships
•Feeling ashamed and guilty about receiving welfare
•Finding suitable and affordable housing
•Difficulties finding or sustaining work, lack of recognition of overseas
qualifications and challenges finding meaningful work
•Feelings of anger and a sense of injustice related to grief about what
she has lost

10. Multiply losses
•Sense of control, safety, trust, certainty, justice
•Loss of loved ones and friends through separation or death
•Cultural norms, place of belonging, community
•Identity, meaning and purpose
•The life built up over many years, plans for the future,
job, schooling
•Physical assets – house, belongings, businesses

11. RELEVANT HISTORY (PRE-MIGRATION)
•Anna described her childhood as a happy one. She is first born, very independent, bright and
responsible. Her brother was 5 years younger. She described her father as her protector. He
died when she was 20, cancer. It was a difficult and meaningful time for her. She started
taking care of her brother.
•She had complicated relationship with her mom, who was GP and often on calls.
•Anna married at the age of 23, husband 6 years older. They have 2 sons. Relationship was
always intense, but good. They respect and support each other despite different values.
•They built a big house and lived there with children and 2 dogs. They were happy.
•She had birth leave vacation for 2 years. Work was always important to her. She felt valued,
had good colleagues and even close friendship with some of them.
•In February 2023 she traveled with her 2 sons and parents to Ireland due to the War in
Ukraine. It was her own decision.

12. RELEVANT HISTORY (POST-MIGRATION)
•Anna lived in apartment with her children and parents (nuclear family). Hotel are full
of Ukrainians. Stay detached and isolated.
•Husband stayed in Ukraine. Brother on the frontline.
•Felt really dependent from parents. No kindergarten for youngest son.
• Poor English, intercultural differences.
•Fights with parents. Not sure about what to do next.
•“Precariat” In sociology and economics, the precariat (/prɪˈkɛəriət/) is a neologism for
a social class formed by people suffering from precarity, which means existing without
predictability or security, affecting material or psychological welfare. The term is
formed from precarious with proletariat.
•Realised how important and meaningful for her to be MD.

13. Ref: Judith Herman, Trauma and Recovery, 1997
Recovery can only happen in the context of relationships.
Development of trust therefore is extremely important.
Recovery in relationships

14. TREATMENT GOALS
In the counsellor’s mind:
•Establish safety and trust
•Help to make meaning of events
•Provide an anchor during chaos
•Separation from and fracturing of
family confers risk
•Psychoeducation and healthy living
•Strengthen internal protective factors
•Trauma reprocessing ?
In Anna’s mind:
• Medication for anxiety
• Validation of injustice and losses
• Stay connected

15. In this model grief operates in two main ways and people switch back and
forth between them as they grieve.
Loss-oriented:
•Things that make you think about your loved one and their death are called
loss-oriented stressors.
•In essence, these are thoughts, feelings, actions and events that make you
focus on your grief and pain
Restoration-oriented
•Restoration-oriented stressors are things that let you get on with daily life
and distract you from your grief for a while even few minutes.
Oscillation
•Oscillation refers to the way that a grieving person can move back and forth
between the two modes of being; loss-oriented and restoration- oriented
Ref: https://whatsyourgrief.com/dual-process-model-of-grief/
The Dual Process
Model of Coping
With Bereavement
Margaret Stoebe and Henk Schut, 1996

16. .
Ref: https://whatsyourgrief.com/dual-process-model-of-grief/
The Dual Process
Model of Coping
With Bereavement
Margaret Stoebe and Henk Schut, 1996

17. TREATMENT PROGRESS
• Anna’s presentation stabilised, reduced the intensity of symptoms
• Stop using medication for anxiety and dyssomnia
•She was enrolled in English classes, has documents in order and is following
medical licence certification approved process well.
•The children are happy, and rivalry isn’t so often
•She even made some friends and started a hobby.
•Less triggered than before by news about Ukraine

18. Reflections
•Ending counselling may trigger previous losses for her
•ear of abandonment
•Therapeutic outcomes may be affected by fluctuating symptoms
due to stressors and crises
•Develop a transition plan?
•Discuss relapse and further support?

19. Social homogeneity
people like one - oneness of Ukrainians!
During world war II people lived under most trying and disastrous
circumstances. When they left their homes in the morning, they
didn't know whether they would return, or, if they themselves
survived whether their belongings, friends, or relatives would. It was
a time of utmost physical insecurity. Yet the spirit of the population
was startling. A great number of people lived in a state of near
elation, and there was little evidence of fear, apprehension, or
resentment. What affected the population more than the impending
danger was the experience of unexpected social closeness. In the
bomb shelters all your alike, all equal. Differences in wealth, social
position, individual skills, and status did not matter. For the first
time in their lives these people experienced a social homogeneity
that broke down the walls, that had hitherto surrounded each
individual and each family.
Rudolf Dreikurs, “Social equality: the challenge of today”, 1972..
.

20. Shelters

21. Orphans

22. You Tube Channel «Кава на ніч»

25. Ann

26. Sofi

27. Ann&Sofi

28. War is still ongoing

29. Contact me
Email
[email protected]

30. References
1.Adler, A. (1979). Superiority and social interest: A collection of later writings. (H.
L. Ansbacher, & R. R. Ansbacher, Eds.) New York: W. W. Norton & Company.
2.Adler, A. (1927). Understanding Human Nature. Oxford: One World Publications.
3.Dreikurs R. (1971). Social equality: the challenge of today.
4.Hooley J.M., Nock K.M., Butcher J.N. (2021). Abnormal Psychology. 
5.Youtube Channel «Кава на ніч»
https://www.youtube.com/channel/UC2ya4VEigL-B5jW3focFo5Aheories of
healthy eating. 
6.https://www.mh4u.in.ua/about/
7.https://edu.mh4u.in.ua/kyrsu/