Consulting to a humanitarian organisation under extreme pressure Multi-level consultation to a trauma-exposed system, Lesvos, Greece, 2019–2021

A charity in Lesvos had transformed rapidly under the pressure of the refugee crisis, evolving from its original mission into an organisation housing and providing psychosocial support to unaccompanied asylum-seeking children across six shelters. Each shelter was staffed by a multidisciplinary team; a group of psychologists, distributed across the shelters, carried responsibility both for direct work with the children and for aspects of the functioning of those local teams. The organisation was operating in a context of intense political hostility and deteriorating conditions on the ground — a broader environment that penetrated directly into the daily reality of the work. Burnout was high, turnover was significant, and the consequences for the continuity of care were serious.

What the psychologists were carrying was not separable from what was happening to the children, or from the macro environment in which the work was embedded. At the heart of the work lay an ethical dilemma familiar in organisations working close to serious risk: between remaining in genuine contact with situations that cannot be fully resolved — accepting the moral distress that entails — and a form of psychological withdrawal that offers relief but at the cost of real engagement. The organisation needed help thinking about this not only at the level of individual staff experience but across its whole system.

The Therapeutic Support Network — a team of five UK-based child psychotherapists and group analysts — was developed in response to these realities, taking shape as both a support structure and a consultative intervention as the work evolved. Regular psychoanalytic and group analytic supervision gave the psychologists space to process what they were carrying and to think about their role within their local multidisciplinary teams. The view across all six shelters that this structure afforded gave the consulting team a systemic visibility that no one inside the organisation possessed — patterns and dynamics that could be brought carefully into consultation with management, increasing awareness of the dilemmas and distress staff were navigating daily. Over time, staff turnover decreased. More significantly, issues of child sexual exploitation that had been disavowed in an environment of overwhelming pressure became more thinkable — and management more able to act on safeguarding concerns with considered agency rather than passive helplessness. In a context structurally hostile to the protection of unaccompanied asylum-seeking children, that shift mattered. The consulting team met regularly among themselves to reflect on what they were seeing across these levels, modelling the reflective practice they were helping the organisation develop for itself. This work is explored in a published chapter on child sexual exploitation in refugee contexts from psychoanalytic and systems-psychodynamic perspectives.

Leadership consultation — team and organisational consultation — trauma-exposed system — safeguarding under pressure — ethical complexity