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On February 24, 2022, therapist Nathalie Timtchenko watched the news in horror.
Russian tanks rolled toward Kyiv, the beloved city where she’d counseled clients for all of her nearly decade-long career. She had recently moved to working in Boston-area psychiatric hospitals while her husband attended graduate school there.
Yet she couldn’t stop thinking about all the friends, family, and colleagues back in Ukraine, sheltering in place as air raid sirens punctured the night air, or others picking up rifles to man checkpoints around the city.
She quickly built a Google form asking fellow mental health professionals to volunteer their services as the Ukrainian nation fought for its existence. She sent the form to all her international networks.
Ping. Ping. Ping. The responses poured in.
After a week, 450 volunteers signed up, some as far away as Australia, Japan, and Israel. Finally, she cut it off after around 1,000 volunteers.
Timtchenko chartered this fledgling group as an NGO, called First Aid of the Soul, within a month.
That international perspective—and the American voice—can be a strategic asset in gathering resources from people around the world following the news and eager to help in some way. That sets FAS apart from other Ukrainian mental health initiatives. While their volunteer corps includes therapists from Senegal and India, more than half are from the U.S.
“I think the West is important because a lot of people see mental health care in particular, as an aftereffect,” Timtchenko said over breakfast at a café in Kyiv in September.
Her experience teaches her that Ukrainians must actually process the emotions of the war on an ongoing basis to sustain people for the time being, in whatever way that means.
“People think [mental health] is something that will be important after the war, when we’re actually processing trauma and trying to recover,” she said. “Actually, if we wait, the amount of need then will be impossible to address.”
An American Perspective Anchored in Ukrainian Voices
In the last three-and-a-half years, First Aid of the Soul’s free volunteer-led Zoom support groups have served more than 17,000 individuals who wouldn’t have been able to afford mental health care otherwise.
Timtchenko recently earned her master’s in public administration from Harvard’s Kennedy School of Government. First Aid of the Soul won funding from the Harvard Innovation Lab’s Student Impact Fellowship Fund and from the Kyiv School of Economics to build full-time coordination staff in Ukraine.
Her team of hundreds of volunteers aims to scale up to revolutionize access to mental health support in Ukraine.
Timtchenko considers herself an “honorary” Ukrainian: an American who grew up in Europe, was educated in Boston, and pursued her career in Ukraine after marrying a man from the country.
“I’m not coming from a place, personally or professionally, that I know what’s best,” Timtchenko said. “But I’m also trying to empower the local community here to be more of a voice and also to get support from elsewhere, because they’re in it right now.”
Insurance doesn’t exist in Ukraine to cover the costs of high-quality one-on-one counseling. Psychotherapy carries stigma left over from the Soviet era, just as therapy was stigmatized in the U.S. until a few decades ago. Mental health conversations have only become mainstream in Ukraine after the full-scale war, as a matter of necessity.
FAS’s method prioritizes taking best practices from cutting-edge research and helping Ukrainians apply them in their own specific urgent settings.
“Here in Ukraine, we do not have the luxury to spend time reading books, about thinking, ‘Oh, what’s the best?’” said Nataliia Yefimenko, director of FAS’s Ukraine branch. “Because it’s war, and we need to be adaptable, also very fast.”
So in the early months of the invasion, the organization’s international volunteer therapists developed a structure of online psychosocial support groups rather than one-on-one counseling.
They based that decision on research showing the importance of forming relationships and belonging through crisis, which helps prevent mental illnesses.
They refer to the groups as “self-compassion” groups to avoid the stigma associated with traditional “support” groups. The casual drop-in style for the virtual sessions is particularly necessary given the uncertainty of wartime. Each session begins with a grounding exercise, then housekeeping, before members share reflections about their current situation.
Their approach values Ukrainian insights into what local residents need, emphasizing that every meeting of FAS’s advisory committee includes Ukrainian voices at the table.
“They helped us, not from miles away, as guests, as people who just have compassion towards us, but she came here,” said Olena Lusenka, a Ukrainian school psychologist volunteering with FAS. “They came to our soil. They felt how it feels like here.”
Serving Families, Cultivating ‘Nadiiya’
Last summer, FAS moved beyond its virtual-first model by launching its “Nadiiya” summer camp for families, supporting families hailing from besieged frontline cities.
The camps, named for the Ukrainian word for “hope,” emphasize family as a supportive system and utilize a trauma-informed approach that allows therapists to create a safe space and express empathy. The Nadiiya project taught self-care techniques to 122 participants last summer, with five distinct cohorts joining for three-week sessions. They engaged in a number of art therapy activities.
While a true “safe space” can be fleeting during a war, retreating to nature is restorative, and art has a way of enabling people to express what feels inexpressible.
“Symbols that people usually draw are universal and have things in common. And so it’s much easier to talk about these symbols than to directly speak about what a person has experienced,” said Emiliya Melnyk, a project director for the organization.
Campers also learned eye movement desensitization reprocessing, or EMDR. For instance, therapists taught them the EMDR “butterfly hug,” which involves crossing both arms over one’s chest and rhythmically tapping the shoulders to help calm the nervous system.
“During the first five days when they were doing this exercise, when they used their breathing butterfly exercise and the movement with their eyes, it became part of their routine,” Melnyk said. “They confirmed that it helped them to lower their intensity of the anxiety or worries that were pressuring them.”
Surveys after the camp showed a 35 percent decrease in symptoms associated with PTSD.
Such sessions were helpful even for the therapists, reminding them that they need to take care of themselves as clinicians, and acknowledge that it’s OK to feel hopeless sometimes. Yefimenko swears by the EMDR technique herself.
“I can breathe, I can talk to you, but at the beginning of the war, for months, I was a nervous wreck,” Yefimenko said.
Psychologists notice a lack of any dreams or goals in young people in frontline regions like Kharkiv, where shellings can be 24/7. Residents find it hard to see beyond their immediate daily survival. One therapist recalled a client asking, “What’s the point of doing school if I’m not going to be here tomorrow?”
Ukrainians traumatized by years of war need this sort of psychological first aid in order to cope on an ongoing basis.
“That’s where a lot of this ongoing care and support is so essential,” Timtchenko said. “Because the people that are providing care now, if they’re burnt out after Ukraine wins, then who’s going to be left to actually help with that?”
