Forced emigration can make a person feel as if they are living between two worlds: physically — already in another country, yet inwardly — still “there.” The rules of life change, as do language, social roles, and the sense of stability and safety. In such circumstances, psychological support is not a luxury — it is a way to regain solid ground under one’s feet.
Mariia Lagodna-Elert — a practicing psychotherapist with more than 20 years of experience — has joined the team of the “From heart to heart” project, implemented by Fundacja HelpNow HUB and Step by Step Fundacja in partnership with Fundacja Res Humanae, with financial support from the Elton John AIDS Foundation.
Below is a conversation about forced migration, professional identity, trauma work, safety in therapy, and the sources of support one can find even in the most difficult times.
– Mariia, you yourself have gone through the experience of forced emigration. What turned out to be the most unexpected part of it for you?
The most unexpected thing for me was precisely the forced nature of this migration. Like many Ukrainians, we did not prepare for the move, we did not plan it, we did not build a strategy. It was not a conscious choice — it was a necessity.And the difficulty of forced migration lies not only in changing countries. It lies in the fact that the inner processes are still unfinished — you are physically no longer at home, yet psychologically you remain there. And at the same time you have to adapt very quickly to new conditions that often differ radically from what you are used to — in the healthcare system, in social rules, in the professional sphere. The skills of functioning in your own country suddenly lose relevance. Not all of them, of course, but there arises a need to form new competencies practically from scratch. It is like a child discovering the world. But there is a fundamental difference. A small child has no prior experience — they explore reality “from a blank page,” without expectations. An adult has a background, established ideas about how things “should be.” And when the reality of a new country does not match these expectations, a strong inner dissonance arises. Planned migration provides support: prepared documents, language, understanding of the labor market, a job found in advance. There is a base you can rely on. In forced migration, this base often does not exist. There is only the experience of a past life and expectations that do not align with the new reality. And it is precisely this mismatch that becomes one of the most difficult challenges.
– Was there a moment when you felt you were starting over — not only your life, but also yourself as a specialist?
Yes, there was such a moment. And it was very tangible. The profession of a psychologist and psychotherapist is directly connected with language — not simply knowing it, but having a subtle feel for meanings, subtexts, nuances, intonation. Language is a working tool. And when you find yourself in another country without knowing it well enough, the first thing I felt was as if I had lost myself as a specialist. It was not easy. It seemed as though part of my professional identity had temporarily disappeared. The turning point was returning to practice — at first through online therapy. When clients gradually began to return, it became a real breath of air. I realized I could work differently — not as before, but no less professionally. The online format opened up new opportunities: working with Ukrainians in different countries, supporting those who are also going through migration, maintaining my practice remotely. And it was this return to the profession — in a new format — that gave a sense of a new beginning. Not only work, but a new stage of life.
– What did emigration change in your view of psychological help?
I cannot say that migration itself radically changed my view of psychological help. Rather, it deepened it. My professional knowledge was enriched by personal experience. And that is a completely different level of understanding. When you yourself go through adaptation, live through a loss of support, confusion, and a rethinking of identity — you begin to feel more subtly the processes migrants experience. There was more empathy for the invisible difficulties: the inner split between “there” and “here,” the sense of temporariness, the fatigue of constant adaptation. I understood more deeply how the forced nature of relocation affects people, how expectation and disappointment work, how self-esteem and professional identity change.
So my professional perspective did not change — it became broader. And more alive.
– Did it become easier or harder for you to work with migrants once you found yourself in that experience?
To be honest, without my own therapy it would have been much harder for me to work with migrants. When you live through forced migration yourself, many client stories can be triggering. Their experiences — about losing home, status, professional support, the feeling of “I’m not who I was anymore” — resonate strongly with your own. And without sufficient internal resources, that could complicate the work. My personal therapy became my support. It helps me separate what is mine from what belongs to the client, recognize my own reactions, and remain in a professional position. Thanks to this, I can be with the client not from the place of “I know how much it hurts,” but from a place of stability and support. So I would say this: the migration experience made the work deeper. But the ability to work well in this area is ensured by my own therapy.
– What personally helps you maintain resilience in a new country?
First of all — my family. I am very grateful to God that I am here together with my husband and children. In the first period my husband became my main support, because he had been in this country even before the start of the full-scale war and already had some understanding of the local reality. That gave a sense of ground under my feet. The professional environment also plays a big role. I have a circle of colleagues — a kind of support group — where I can be honest, discuss difficult cases, share feelings. It is a very valuable resource. And, of course, my personal therapy and supervision. They help me maintain inner balance, be aware of my processes, and have enough support to keep moving forward — both in life and in my profession.
– Mariia, how do you describe your role today: psychologist, psychotherapist, crisis specialist? What matters most to you in this work?
Today, first and foremost, I feel like a psychotherapist. That is how I define myself internally.
My professional path has been long and consistent: from working as a psychologist in a psychiatric hospital, as a clinical psychologist — to many years of training in psychotherapy, personal therapy, and supervision. It was a process of becoming — deep and gradual. And today I love the craft of psychotherapy the most. I feel close not only to the result, but also to the process itself — attentive presence, exploring a person’s inner world, careful work with their experiences and changes. I see myself specifically as a psychotherapist — a specialist who works not only with symptoms, but with the person, their story, meanings, and inner supports.
– You have worked in the Gestalt approach for many years. In two or three sentences: what exactly does it give people in crisis and in emigration?
Gestalt therapy gives a person the opportunity to stay in contact with themselves — with their body and emotions — and to remain in the “here and now.” And that, in turn, helps them ground themselves and feel support. Therapy also helps a person live through their experience and emotions — not reject them and not forget them, but live through them, because living through pain becomes a path to healing.
– What requests do you most often see from forced migrants and refugees — and what truly helps in the first 1–3 sessions?
The most frequent request is the absence of a sense of safety. Many people, even in relatively calm conditions, do not feel safe internally. The body continues to live in threat mode. And then the first task becomes stabilization — a gradual return of a sense of support, control, predictability.
Also, at the beginning of the full-scale war, many clients said that they “stopped thinking normally,” “as if they began to reason worse.” This is a natural reaction of the psyche to danger: when there is a threat, the activity of the cerebral cortex decreases, and a person shifts into survival mode. And again — it is about the loss of a sense of safety. Therefore, in the first 1–3 meetings, the most important thing is not deep analytical work, but stabilization. Creating a safe therapeutic space, normalizing reactions (“you are okay; this is a natural response to traumatic events”), basic grounding techniques, restoring contact with the body and reality. When a minimal sense of inner stability appears, then it is possible to move further.
The second frequent layer is relationships. Migration often radically changes the family system. If we speak about Ukrainians, someone close may remain in Ukraine: a husband, parents, relatives. Distance, long separation, different living conditions — all of this adds strain to relationships. New conflicts emerge, questions of trust, a sense of emotional distance. Another very frequent request is the loss of identity. A person stops feeling like who they were in their country. Professional status, social role, familiar circle of communication, even language — all of this changes or temporarily disappears. And with it comes the inner question: “Who am I now?”
In migration, many people face a sense of self-devaluation, as if their previous experience no longer has weight. This is a very painful process. Therapy in this case is not a return to an “old version of yourself,” but a gradual discovery of a new one. A careful process of integration: preserving your past experience while simultaneously forming a new “self” that already takes into account the reality of another country. And this process requires time, support, and inner safety.
– In your experience, you work a lot with trauma, anxiety, panic attacks, shame, guilt. What signals suggest that a person needs stabilization first, rather than “analyzing causes”?
If we talk about guilt and shame, it is important to understand what stands behind them.
Trauma is not always about physical danger. It can be a danger to my “Self” in contact with others. For example, in relationships with parents in childhood, an attachment trauma may have formed — when love was conditional, when a child experienced rejection, criticism, emotional coldness, or unpredictability. In such cases, shame and guilt become a way to preserve the bond: “something is wrong with me” instead of “I am being treated in a dangerous way.”
Then the work is longer. It is connected with restoring the experience of healthy relationships, with forming safer attachment, with gradually changing the internal model of contact. And in this process it is truly important to explore the causes — where these feelings came from, in which relationships they were formed (in the family, at school, in other significant relationships).
In contrast, work with trauma or panic attacks usually involves a specific situation of danger in the past that the psyche could not cope with in the moment. There, the priority becomes stabilization and safe processing of this experience. So in each case it is important to distinguish: are we dealing with an activated state of danger that requires stabilization, or with deep feelings of shame and guilt formed in relationships that require longer therapeutic work with their roots.
– You use different methods (including EMDR/ASSYST, Brainspotting, EFT). How do you choose what fits a particular person so that it is gentle and safe?
For me, the key criterion is the client’s state and the type of traumatic experience.
For example, ASSYST is one of the EMDR protocols that works well for processing a relatively “fresh,” single traumatic event that happened recently (roughly within the last year). But it is not an optimal tool for old, deeply rooted, or complex traumas. If I see complex traumatization, the first stage is always stabilization. Sometimes it can take a long time — months, and sometimes a year or more. Without enough resources and an expanded “window of tolerance,” deep trauma processing can be too intense.
EMDR is an effective method, but when working with severe traumatic memories, the client can become emotionally “flooded.” If the nervous system is not ready, it can be too strong an experience.
In such cases, I may suggest Brainspotting. This method allows gentler work: through focusing on bodily sensations and the inner process, with attention to a specific eye position. Sometimes the client does not even go into detailed memories — the process unfolds at a deeper, neurophysiological level. This makes it possible to gradually expand the window of tolerance while carefully touching traumatic material. I use EFT and other regulation techniques when it is necessary to activate the parasympathetic nervous system — reduce anxiety, stabilize the state, and restore a sense of control over the body. So the choice of method is not about “which tool is better,” but about what is safe for this person at this moment and whether they consent. I always orient myself to the level of resources, the capacity to withstand intense experiences, and the pace that suits this particular client.
– What safety rules do you consider basic in trauma work in order not to retraumatize a person?
The first and key principle is the presence of another person. In trauma work, the client should feel real contact with the therapist: that they are not alone in this experience, that there is a stable, holding figure nearby. Trauma is often connected with experiencing isolation and loss of control. When a difficult experience is “shared” with another, it becomes more bearable. If I carry it alone — it is unbearable. If I can share it — support appears. The second principle is mandatory stabilization before processing trauma. We need to understand what type of trauma we are working with and how deep the preparation should be. Even if the stabilization stage is short, the client must master basic techniques:
– grounding,
– breathing regulation,
– finding inner and outer resources,
– skills of “containing” painful experiences,
– bringing oneself back to the “here and now.”
This is important so that in the processing work, if a person goes beyond the window of tolerance, they already know how to help themselves. We do not start learning from scratch in a moment of crisis. The third principle is control in the client’s hands. In trauma, control was lost. In therapy, it is returned. The client always has the right to say “stop,” slow down, change the topic. This is a fundamental safety rule. If overload arises during the work, we immediately return to stabilization and stay there as long as needed. The fourth principle is that there is no need to retell every detail of events.Modern methods such as EMDR or Brainspotting allow working with traumatic memories without detailed verbal retelling of every detail. Sometimes internal activation of the memory is enough to begin processing on a neurophysiological level. This significantly reduces the risk of retraumatization. And one more important point: we do not process “everything at once.” The work proceeds gradually: separate memories, the most charged episodes (the first, the last, the most vivid), forming a kind of map of experiences. And then we work with these fragments consistently and carefully. Safety in trauma work is not speed. It is a pace the client’s nervous system can handle. Another mandatory element in my work is psychoeducation.
I always explain to clients what is happening to them: why the body reacts this way and not otherwise; why panic attacks, flashbacks, numbness, or, on the contrary, hyperarousal appear. When a person understands how the nervous system works, the level of anxiety decreases significantly. It is very important that the client does not perceive their symptoms as “something is wrong with me.” On the contrary — these are natural reactions of the psyche to abnormal events. I also explain what exactly we will do in therapy, why a particular technique is needed, how it works, and what result we expect. This returns a person’s sense of control and participation in the process. Psychoeducation is not just information. It is a way to reduce fear of one’s own reactions and create a safe, conscious therapeutic process.
– How do you set boundaries: what clearly belongs to the help a foundation psychologist provides, and what already requires another specialist (psychiatrist, doctor, lawyer, social worker)?
For me, the key is a clear differentiation of professional competence. I always ask myself: is this within the scope of psychological/psychotherapeutic work, or is it already the domain of psychiatry or another specialization? My clinical experience working in a psychiatric hospital helps me see symptomatology — for example, the depressive triad, signs of severe mood disorders, possible psychotic manifestations. If needed, I can use psychodiagnostic tools to better differentiate the condition. But if I see that this is a disorder requiring medication treatment or psychiatric support, I обязательно refer the person to a psychiatrist. My task is not to replace a doctor and not to comment on or interpret medical diagnoses. That is not my area of responsibility. If the issue concerns legal or social difficulties, my role is emotional support. I help the client withstand tension, cope with anxiety, and find inner resources to get through a difficult situation. But I do not take on the functions of a lawyer or a social worker.
Sometimes my work includes helping with accepting a diagnosis, normalizing the state (“you are not the only one with this experience”), reducing stigma around medication treatment, and supporting motivation to follow a doctor’s recommendations. But this is always psychological support — not medical decisions.
– You have experience working with LGBTQ+ people and training medical staff on preventing discrimination toward people living with HIV. What do you consider the most common source of pain for people from stigmatized groups — and how do you work with it in a supportive way?
Most often, the source of pain is not the identity itself and not the diagnosis. It is the experience of rejection, stigma, and inner isolation. When a person repeatedly faces condemnation, devaluation, or discrimination, an inner tension forms: “something is wrong with me,” “I am dangerous,” “I have no right to be visible.” And very often external stigma gradually turns into internal stigma — a person begins to look at themselves through the eyes of a discriminatory environment. This creates chronic stress, increased anxiety, difficulties in building close relationships, shame, fear of openness, отказ from medical services, isolation. Particularly painful is the experience of rejection from family or significant figures. In my work, it is important first and foremost to create a safe space without judgment. A space where identity or HIV status is not a “problem,” but a part of the person’s life. This helps work with internal stigma.
– How do you create a sense of safe space for someone who has repeatedly faced judgment or unsafe situations?
The first step is clearly stated confidentiality. A person needs to know that everything they say in therapy stays between us. This is the basic level of safety. But in reality, a safe space is created not only with words. People who have faced stigma, discrimination, or judgment for years are extremely sensitive to nonverbal signals. They very subtly read intonation, pauses, facial expressions, shifts in gaze. The slightest sharpness in the voice, a hint of evaluation, a raised eyebrow, an overly intent or, conversely, detached look — and the person immediately goes into alert mode. That is why a safe space is, прежде всего, contact. A calm tone of voice, soft, unhurried speech that helps grounding. An accepting, stable gaze without surprise or a hidden reaction to status, identity, or the client’s experience. An open, even body posture.It is important that all of this is not a technique, but authenticity. If what I say and what my body conveys match — a person feels it. And only then does the possibility appear to gradually relax and begin to trust. A safe space is not a declaration. It is an experience of contact that the client lives through with their senses.
– You have extensive experience in interdisciplinary work (psychiatrists, doctors, teams). What does ideal collaboration within the foundation look like to you so that support is holistic?
Ideal collaboration within the Foundation begins with the team’s clear understanding of each specialist’s roles and competencies. Everyone should know whom they can refer a client to — and do it not formally, not simply “Go there,” but concretely, describing needs and the request.
For example, if a client needs social or legal support, the psychologist can write to the social worker: “This person needs help with new or emerging problems that appeared during the consultation.” Then the social worker immediately knows how to support the client, and the client’s anxiety level decreases because they see clear steps — and awareness also reduces anxiety. It is also important to voice your competence boundaries during the consultation. If I cannot answer a legal or medical question, I say so directly and refer to the appropriate specialist. Misunderstanding or attempts to answer outside one’s field can increase the client’s anxiety if I say something incorrectly. For me, the key principle is constant communication between specialists, the ability to consult and share experience — both professional and personal. This allows creating a holistic, safe, and effective support space where the client feels supported at all levels — psychological, medical, social, and legal.
– You have led Balint groups and burnout prevention. What helps teams avoid “burning out” in helping work, especially in NGOs?
The main way to prevent burnout is changing activities. If you work as a psychologist or psychotherapist and carry a high emotional load, it is important to switch to physical or other activity that allows you to “release” emotional tension. This gives the body and psyche rest and recovery. Support from colleagues is very important. A place where you can “let off steam,” share experiences, discuss difficult cases significantly reduces the risk of burnout. In helping professions, emotional burnout is directly connected to “person-to-person” work: we are constantly in contact with others’ pain, anxiety, and suffering, and it affects us.
Another factor is awareness of one’s own limits and acceptance of limitations. We are not gods, and we cannot do absolutely everything for every client. Often the results of our work are not visible immediately or are small, and this can create the feeling that “I’m doing nothing” or that my work does not matter. Balint groups help overcome these feelings: exchange of experience, feedback, and colleagues’ support restore meaning and value.
So the burnout-prevention комплекс includes:
• changing activities to restore resources;
• regular peer support and supervision;
• awareness and acceptance of one’s limits;
• support of Balint groups and the opportunity to share experience.
All of this creates conditions for resilience and safe help both for the team and for clients.
– What would you say to someone who hesitates: “I feel uncomfortable asking for help” or “it’s not serious enough”?
First, the feeling “I’m uncomfortable asking for help” or “I don’t have it as bad as someone else” is very characteristic of our mentality. We are used to surviving, not living, and we often perceive acknowledging the need for support as a sign of weakness. For many clients, this is truly a critical moment — admitting they need help. It is important to understand that asking for help is not weakness, but a position of strength. It shows awareness and the ability to care for oneself, recognize one’s limits and needs. It is not humiliation, but a resourceful action that makes a person more resilient and more grounded for themselves and those around them.
As for the thought “it’s not that serious”: people often compare their pain to someone else’s — for example, someone lost a loved one, while someone else experienced the loss of home or a familiar life during the war. But pain has no “rank” or “comparison.” Every loss is real and painful. The experience of a migrant who lost their home, familiar way of life, social ties is also real pain — and it deserves support. So reaching out for help is an act of strength, self-respect, and self-care. It allows you to recover, become stronger, and in the future be a support for others. Support is not a luxury — it is an essential resource for healthy life and a healthy society.
– Name 3 simple self-support techniques for intense anxiety/panic that you often give at the beginning of work.
Here are three effective techniques that help you ground yourself, regain control over the body, and reduce anxiety:
The grounding technique “5-4-3-2-1”
This exercise helps you return to the “here and now” through bodily sensations and the environment.
5 senses: notice five things you can see around you.
4 touch sensations: notice four tactile sensations — for example, the coolness of a tabletop under your hands, the roughness of a carpet under your feet, the wind on your face.
3 sounds: listen for three sounds — a clock, birds, the distant hum of cars.
2 smells: notice two smells — coffee, perfume, a candle.
1 taste/sensation in the mouth: notice the taste in your mouth, or take a small bite of food and notice its taste.
A breathing technique to activate the parasympathetic nervous system This helps restore balance between the sympathetic and parasympathetic systems. Choose a rectangular object (a door, a monitor, a phone). Inhale while guiding your gaze along the short side of the object, then hold your breath. Exhale while guiding your gaze along the long side, then hold your breath again.
Repeat for 1–2 minutes. Your breathing becomes controlled, with a longer exhale, which activates the parasympathetic nervous system and brings a sense of calm.
The “Butterfly” technique This exercise grounds and rhythmically calms the body. Cross your arms over your chest so that your fingertips touch the upper part of the lungs, or place your hands on your shoulders, or under the collarbones.Gently tap alternately with your fingers: left hand, right hand, left again.
You can match the tapping rhythm to your heartbeat — it should be slow tapping. . Do it for 3–5 minutes to feel stability and reduce anxiety. These simple techniques can be used even at the beginning of a session or in moments of distress to quickly regain control over bodily and emotional reactions.
– What in your practice over the past years has most strongly strengthened your faith in people and in recovery after crisis?
Observing migrants who find themselves in a foreign country, I see how people “grow again” — as if from ashes. In psychology, there is even a concept of post-traumatic growth: people learn to find new meanings even if they have lost the past. If we talk about people who remain in Ukraine now, it is striking how powerfully they adapt to radically changed conditions. There is physical danger, lack of electricity and water, difficulties with transportation and getting to work. And yet they find ways to adjust, survive, organize their lives. This demonstrates the incredible strength of the psyche and the body’s natural orientation toward survival. Such resilience and adaptability inspire and give hope that a person can cope even with extraordinary circumstances. I always remember a metaphor from supervision many years ago. This very metaphor supported me for these 4 years. We were working with a case of loss, and outside the window in the Carpathians there was a forest. My supervisor pointed to a burned spruce tree and said: “Look — after some time a new forest will grow on this ash. Ash becomes fertilizer, seeds remain, they mature, favorable conditions appear — spring comes, warmth comes, and new trees sprout.” The same is happening now with people who have experienced forced migration, and with those in Ukraine who are living through the war. Their task is to give themselves a new life, create “new shoots,” new possibilities. And I see how they build a career, a business, new relationships, friendships, support from scratch. Some, despite their own difficulties, help others: they weave nets for the military, support volunteer projects. This is an incredible discovery of new horizons and resources for a person. Those who survived and rebuilt their lives become stronger, broader inside, with more possibilities. This is what most strengthens my faith in people and in their ability to recover after crisis.
– If you could say a few words of support to people who are currently going through emigration, trauma, or an inner crisis, what would it be?
When I first faced forced migration myself, there was a feeling that the world had collapsed and that the situation would remain this way forever. Four years passed, and now, looking back, I understand: the picture changes, a person grows, and finds new opportunities. I want to remind everyone who is going through emigration, trauma, or crisis now: look into the future — 5, 10, 15 years ahead. Truly, you will not remain at the point where you are now. You are moving, looking for a new job, new friends, support, working through your state. Every small step leads you to changes, to new opportunities.Treat what is happening to you now as a new experience. Maybe it is hard, maybe painful — but it is precisely what helps you become stronger and gives you a chance to grow again. As in the metaphor about burned trees: on the place of burned spruces, a new forest grows with time. This is the force of life — unshakable; it always works toward renewal. Our brain and body are built to survive — and we will survive. I sincerely believe that.
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This publication was prepared within the framework of the project “From heart to heart” in partnership with Step by Step Fundacja, in partnership with Fundacja Res Humanae, with financial support from the Elton John AIDS Foundation.
