Can Sense of Coherence Moderate

Can Sense of Coherence Moderate

Traumatic Reactions? A Cross-Sectional

Study of Palestinian Helpers Operating

in War Contexts

Guido Veronese*, Francesca Fiore, Marco Castiglioni,

Hassan el Kawaja, and Mahmud Said

Guido Veronese, Ph.D., is a fellow researcher in clinical psychology, family psychotherapist and

family mediator. Francesca Fiore (Ph.D.), cognitive behavioural psychotherapist and

psychometrist, is working at ‘Studi Cognitivi’, Psychotherapy School. Marco Castiglioni

(Ph.D.) is associate professor in clinical psychology working at University of Milano-Bicocca,

Department of Human Sciences. Hassan el Kawaja (MD) is psychiatrist and specialist in

trauma intervention working at Psychiatric Hospital in Gaza Strip. Mahmud Said (MD) is

Ph.D. attendant at Milano-Bicocca University, Educational Psychologist and director of the

Educational Psychology Service, Iksal, Israel.

*Correspondence to Guido Veronese, Ph.D., Department of Human Sciences ‘R. Massa’,

University of Milano-Bicocca, P.zza dell’Ateneo Nuovo, 1, 20126 Milano, Italy. E-mail:


This study explored the moderating effect of sense of coherence on the impact of

trauma and psychological health in a group of helpers and social workers operating

in war contexts.We hypothesised that a strong ability to construct meaning in uncertain

and traumatic conditions would favour psychological well-being and quality, limiting

the direct and indirect effects of war-related trauma. Three self-reported measures—

Sense of Coherence (SOC-29) Scale, Impact of Events Scale (IES) and General Health Questionnaire

(GHQ)—were completed by 140 helpers operating in the West Bank and the

Gaza Strip (Occupied Palestinian Territories). Multivariate analysis of variance, partial

correlational analysis and mediation (path) analysis were carried out to verify the

effects of sense of coherence on psychological stress and trauma. The moderating

effect of sense of coherence on mental health and impact of trauma was confirmed.

No gender differences emerged in the subgroups. Implications for civilian populations

affected by war are discussed.

Keywords: Palestinian helpers, political violence, psychological well-being, sense of

coherence, impact of trauma—war

# The Author 2012. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.

British Journal of Social Work (2012) 1–16


British Journal of Social Work Advance Access published February 20, 2012

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Accepted: December 2011


Professional social workers, volunteers and emergency workers operating

under life-threatening conditions in war contexts are commonly at risk of

developing moderate to severe trauma-related symptoms, depending on

whether they are directly or indirectly exposed to critical events (Koren

et al., 2009; Shamai and Ron, 2008; Ramon et al., 2006; Arvay and

Uhlemann, 1996). Studies on secondary indirect stress report low to

moderate incidence of post-traumatic stress disorder (PTSD) following

indirect exposure and moderate to high incidence following direct exposure

to traumatic events (Koren et al., 2009). For example, 20 per cent of individuals

directly exposed to the 9/11 terrorist attacks in New York developed

PTSD (Galea et al., 2002a, 2002b; Schlenger et al., 2002) versus 4 per cent of

individuals indirectly exposed to the attacks (Schlenger et al., 2002). In

addition, clinical social workers and helpers engaged with severely traumatised

populations are frequently affected by phenomena such as vicarious

traumatisation (VT), secondary traumatic stress (STS) caused by stress

factors and overlapping catastrophic events, and compassion fatigue, an

empathic and emotional overinvestment due to ongoing exposure to

tragic events in the lives of their clients (Bride, 2007; Bride et al., 2007;

Adams et al., 2006). In the latter case, helpers present symptoms, although

they are not directly involved in violent events (Figley, 1995). In other

words, a sort of contamination may take place when the helpers are

witness to extremely traumatic episodes (Figley, 2002).

Nevertheless, helpers in war zones frequently report feelings of personal

growth, increased sensitivity and empathy as well as increased resilience

and self-efficacy (Baum and Ramon, 2010). Batten and Orsillo (2002)

showed that therapists who experienced greater emotional intensity in

the wake of 9/11 were more successful in connecting with their clients’ emotions

and responded more empathically and effectively to their clients’

needs. Lev-Wiesel et al. (2009) reported positive psychological change

and PTG (post-traumatic growth) in Israeli social workers and nurses operating

during the 2006 Lebanon War (Calhoun and Tedeschi, 2006). In a

study carried out in Israel, Shamai and Ron (2009) reported that helpers

may experience the assistance provided to victims of terror and their

families as personal and professional growth. Lindsay (2007) found that

Palestinian helpers wished to play a positive role in the society by investing

in their own professional work, and that this was sometimes reflected in

enhanced connection with clients and their experiences. In addition,

acute and post-traumatic symptoms and consequences of exposure to war

can be limited by a range of individual factors such as personal resources

(Galea et al., 2002a; 2002b) and resilience, defined as the ability to maintain

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positive psycho-social functioning despite environmental adversity

(Tedeschi and Kilmer, 2005). Helpers can develop a feeling of ‘potency’,

namely strong adherence to a social and moral order that makes them

feel part of an upright and honest society that provides social support to

individuals (Solomon et al., 1998). Finally, they may become ‘activists’,

deploying individual ability to take part in a social context that makes

sense of events by putting up a struggle to resist the pressures of a threatening

group (Barber, 2008; Lewin, 1948).

The sense of coherence (SOC) concept, first introduced by Antonovsky

(1993, 1987, 1979), provides a helpful framework for integrating individual

and contextual factors. SOC is a stable global construct that is universally

meaningful, cutting across lines of gender, social class and culture (Sagy

and Antonovsky, 2000). It is a global tendency expressing the degree to

which an individual has a pervasive, durable and dynamic feeling of confidence

that internal and environmental stimuli are structured, predictable

and explainable (Comprehensibility); that resources are available to meet

the demands posed by these stimuli (Manageability); and that these

demands are challenges, worthy of investment and engagement (Meaningfulness).

Accordingly, it is a major factor affecting individual ability to deal

with traumatic events such as war and terrorism (Kimhi et al., 2010). Dudek

and Koniarek (2000) noted that a higher level of PTSD was associated with

a lower SOC among firefighters. High SOC and spirituality have been

found to positively correlate with lower stress and superior quality of life

in chronic patients (Delgado, 2007; Poppius et al., 1999). Finally, individuals

with a low SOC are less confident of adapting to the adverse effects of their

life experiences than those with a higher SOC (Konttinen et al., 2008;

Surtees et al., 2006).

Starting from these perspectives, the aims of this study were to explore

the effects of war on emergency workers’ underlying resilience factors, as

indicated by their SOC (known to facilitate positive adjustment to traumatic

events); to evaluate the functioning of helpers in the light of the

power of the individual and personal context to make sense of political

and military violence; and, finally, to investigate differences between a

group of Gazan helpers who had suffered recent extreme trauma

(January 2009) and a group of Tulkarm (West Bank) helpers in a posttraumatic

phase and a context of low-intensity warfare. Specifically, we

attempted to answer the following questions:

(1) Are there differences in SOC between the two groups of professional

helpers? (West Bank versus Gaza)

(2) Are levels of traumatisation lower in one of the two groups?

(3) Are levels of general psychological distress lower in one of the two


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(4) Is SOC (or any of its subscales) a mediator between the impact of trauma

and general psychological health (see the conceptual model in Figure 1)?

Implications for the quality of life and well-being of war-affected populations

will be discussed.

The background

Tulkarm City is a town in the West Bank characterised by the presence of

two refugee camps (Tulkarm City and Nurshams) that host around 27,000

‘internal refugees’. The population is extremely poor on account of

unemployment following the closure of the borders after the second Intifada

in 2002 (Al-Aqsa Intifada) (Esposito, 2005). The helpers’ work and

their quality of life in terms of freedom of movement, safety and general

well-being are compromised by the precarious conditions affecting the

territory: territorial discontinuity, the separation barrier, fixed and mobile

check points and curtailing of basic resources. Recent years have been characterised

by a form of low-intensity conflict (night-time incursions, imprisonments

and targeted murders, mobile checkpoints and surprise

curfews) creating a climate of uncertainty and terror amongst the civilian

population (Veronese et al., 2010).

Gaza City is a highly populated city in the Gaza Strip that is controlled by

the political faction, Hamas. In December/January 2008–09, the Israeli

Defence Forces (IDF) attacked the city during the operation ‘Cast Lead’,

causing severe infrastructural damage and approximately 1,400 casualties,

the majority of whom were civilians (Cobban, 2010; Giacaman

et al., 2009). This ‘high-intensity’ conflict has come on top of chronic

poverty and unemployment caused by the trade embargo and total

border blockade that have been progressively enforced since 2005 in opposition

to the rise to power of Hamas. Two large-scale refugee camps (Jabalya

and Al-Shati Camps, with a joint population of approximately 180,000

people) add to the gravity of the situation. The economic and social

Figure 1. Conceptual Model with Sense of Coherence as Mediator between Trauma and

Psychological Distress.

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restrictions in place in Gaza have had devastating impacts on both the

economy and public health (Giacaman et al., 2009).



Participants in the study were 114 Palestinian helpers, forty-seven males

(age A ¼ 30.4; SD ¼ 7.63) and sixty-seven females (age A ¼ 29.3; SD ¼

6.4). Of these, sixty operated in Tulkarm City and fifty-four in Gaza City.

The majority were social workers and counsellors employed by local and

international NGOs (see Figure 2).

Instruments and procedure

Participants completed three self-reported instruments. The first instrument,

the Impact of Events Scale (IES) (Horowitz et al., 1979), was used

to assess trauma-related symptoms in helpers. The second measure, the

Sense of Coherence Scale (SOC-29) (Antonovsky, 1979), was chosen to

evaluate participants’ ability to attribute sense to traumatic experiences

and environments. Finally, the General Health Questionnaire (GHQ)

(Goldberg, 1972) was adopted as a measure of psychological illness in

helpers and therefore as an indirect measure of relative psychological


With regard to the Impact of Events Scale (Horowitz et al., 1979), we

used the Arabic Version by Dyregrov, Gjestad and Raundalen (2002).

Figure 2. Distribution of Professions for Entire Sample.

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The IES was originally devised by Horowitz and colleagues (1979) to assess

the emotional sequelae of extreme stress. The questionnaire describes

fifteen emotional reactions and the respondent is asked to indicate how

frequently each reaction has been experienced in the preceding week on

a four-point scale ranging from ‘not at all’ to ‘often’. Scores are obtained

by assigning the values 0, 1, 3 or 5 to the corresponding frequency

categories. The IES is made up of two subscales: Intrusion, namely

unwanted memories of the event, and Avoidance, namely attempts to

avoid reminders and numbing of emotional responsiveness. Horowitz

et al. (1979) reported high internal consistency for both subscales (Cronbach’s

alpha for Intrusion ¼ 0.79; for Avoidance ¼ 0.82).

Concerning the Sense of Coherence Scale, based on the sense of coherence

construct (Antonovsky, 1979, 1987, 1993) and devised by Antonovsky

(1979), we administered the Arabic Version by Cohen and Savaya (2003).

The SOC-29 is made up of three subscales:

a. Comprehensibility: the perception that events, including extremely negative

events such as death and war, are understandable at a cognitive level,

coherent and predictable in the future.

b. Manageability: a belief that you have the skills or ability, the support, the

help, or the resources necessary to take care of things, and that things are

manageable and within your control.

c. Meaningfulness: a belief that things in life are interesting and a source of

satisfaction, that things are really worth it and that there is good reason or

purpose to care about what happens; a perception of relevance in dealing

with difficulties and trust in the success of the fundamental values of live.

Finally, turning to the General Health Questionnaire (Goldberg, 1972),

we administered the Arabic Version (Daradkeh et al., 2001). The GHQ

has been extensively used in a wide range of settings and cultures since

its development by Goldberg in the 1970s as a measure of current mental

health. It is an indirect measure of psychological well-being because it

records stress symptoms that may indicate the presence of a disorder.

The GHQ-12 is brief, simple and easy to complete; its application as a

screening tool in research settings is well documented (Pevalin, 2000).

Each item is rated on a four-point scale (less than usual, no more than

usual, rather more than usual, or much more than usual); total scores of

12 or 36 are obtained, depending on the scoring procedure selected. The

most common scoring methods are bi-modal (0–0–1–1) and Likert

scoring styles (0–1–2–3) (Pevalin, 2000); in this study, we used the latter


Data analysis

Descriptive analysis of levels of trauma, mental health and sense of coherence

was carried out using SPSS PASW Statistics 18.

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A correlation analysis (Pearson’s r) and a partial correlation analysis with

age and gender as control variables were conducted for both the entire

sample and the two geographical subgroups in order to determine the

degree of association between the self-reported measures of sense of coherence,

impact of trauma and psychological distress.

Gender and age differences across the entire sample and for each of the

two subgroups were tested for using a multivariate analysis of variance


Mediation analysis, specifically the Sobel test (1982), was conducted to

test a model of how general psychological distress (GHQ total score)

might be predicted by impact of trauma and sense of coherence. The

model was tested following the four-step regression procedure recommended

by Baron and Kenny (1986), measuring in turn: the effect of the

independent variable on the dependent variable; the effect of the independent

variable on the mediator; the effect of the mediator on the

dependent variable; the effect of the independent variable on the

dependent variable, when controlling for the mediator. Specifically, we

used regression to test the hypothesis that traumatic events (IES) influenced

general psychological well-being (GHQ) mediated by SOC

(Figure 1). In order to run this type of regression analysis, it is sufficient

that residuals be normally distributed.


In the following paragraphs, we report and discuss the results of this

exploratory work. Table 1 displays the group means and standard deviations

for scores on each of the research measures. The IES average scores

reflect a moderate level of trauma on both Intrusion (I) and Avoidance

(A) subscales, given that scores in the range of 0–8 denote subclinical

trauma, scores of 9–25 moderate trauma and scores of 44–75 severe

trauma (Horowitz et al., 1979). The GHQ scores reflect good general

Table 1 Means and standard deviations for SOC, IES and GHQ scores


Comprehensibility 45.58 8.13 114

Manageability 36.61 6.31 114

Meaningfulness 38.92 7.44 114

Intrusion 9.22 4.85 114

Avoidance 11.50 5.58 114

GHQ 12.03 6.34 114

Note: Comprehensibility, Manageability and Meaningfulness are the subscales of SOC ¼ Sense of Coherence

Scale; Intrusion and Avoidance are subscales of IES ¼ Impact of Events Scale; GHQ ¼ General

Health Questionnaire.

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psychological well-being. The scores for all SOC subscales indicate a high

sense of coherence with regard to both the comprehension of events and

their manageability and meaningfulness.

Table 2 summarises the correlations found between sense of coherence

and the other study measures for the entire sample. Manageability and

meaningfulness were negatively correlated with Intrusion, Avoidance and

GHQ. This finding was replicated when gender and age were controlled for.

Table 3 reports the correlations for the Gazan subgroup. Manageability

and meaningfulness were negatively correlated with Intrusion, Avoidance

and GHQ, and comprehensibility negatively correlated with GHQ. When

gender and age were controlled for, manageability and meaningfulness

remained negatively correlated with Intrusion.

Table 4 presents the correlations for the West Bank subgroup. In this

case, manageability was negatively correlated with Intrusion and GHQ,

and meaningfulness with Intrusion, Avoidance and GHQ. This finding

was replicated when gender and age were controlled for.

Table 2 Correlations between SOC scores and IES/GHQ scores for entire sample

Measures Intrusion Avoidance GHQ

Comprehensibility –0.06 0.08 –0.12

Manageability –0.42** –0.22* –0.33**

Meaningfulness –0.46** –0.29** –0.49**

* p , 0.05; ** p , 0.01. Note: Comprehensibility, Manageability and Meaningfulness are the subscales

of SOC; Intrusion and Avoidance are subscales of IES; GHQ ¼ General Health Questionnaire.

Table 3 Correlations between SOC scores and IES/GHQ scores for Gaza group

Measures Intrusion Avoidance GHQ

Comprehensibility –0.09 –0.01 –0.30*

Manageability: –0.47** –0.26* –0.30*

Meaningfulness –0.45** –0.20 –0.37**

* p , 0.05; ** p , 0.01. Note: Comprehensibility, Manageability and Meaningfulness are the subscales

of SOC; Intrusion and Avoidance are subscales of IES; GHQ ¼ General Health Questionnaire.

Table 4 Correlations between SOC scores and IES/GHQ scores for West Bank group

Measures Intrusion Avoidance GHQ

Comprehensibility –0.09 0.12 –0.03

Manageability: –0.44** –0.16 –0.43**

Meaningfulness –0.52** –0.36** –0.64**

* p , 0.05; ** p , 0.01. Note: Comprehensibility, Manageability and Meaningfulness are the subscales

of SOC; Intrusion and Avoidance are subscales of IES; GHQ ¼ General Health Questionnaire.

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An ANOVA was carried out to test for differences between the

geographical subgroups on the study measures (two groups x six study measures)

and no statistical differences were found (F(5.26) ¼ 1.26; p ¼ 0.27).

Similarly, a MANOVA was conducted to test for differences as a function

of profession. We divided the sample into counsellors, psychologists,

medics (doctors and head physicians), social workers (general and education),

nurses and other. A statistically significant difference was found

(F(35.24) ¼ 0.44; p ¼ 0.01). Specifically, nurses had a stronger sense of

coherence than medics, while psychologists displayed greater psychological

distress than medics, nurses and counsellors despite obtaining higher sense

of coherence scores (see Table 5).

With regard to the mediation analysis, a series of tests

(Kolmogorov-Smirnov, Shapiro-Wilk, Normal Q-Q plot, Detrended

Normal Q-Q plot) showed that the residuals were normally distributed.

Neither the histogram nor the probability–probability plot indicated that

the assumption of normality was violated. A regression analysis was then

conducted to test for complete mediation (i.e. significant effects of the independent

variable, IES, on the dependent variable, GHQ, and on the mediator,

SOC, and of the mediator on the dependent variable, as well as a

statistically non-significant direct effect of IES on GHQ) or partial mediation

(i.e. as before but with a significant direct effect of IES on GHQ).

The model was confirmed with IES as the independent variable of a

process in which SOC was either a mediator or a moderator and GHQ

was the dependent variable (Figure 3 and Table 6).


Our results provide partial answers to the questions rising from the research

hypothesis. In line with the current literature on extreme trauma, Intrusion

Table 5 Comparison means of measures on different group profession

Counsellor Medic Nurse Psychologist Social worker

M (SD) M (SD) M (SD) M (SD) M (SD)

SOC total a,b,c 118 (13.8) 114 (16.2) 127 (14.2) 125 (13.4) 125 (13.3)

Comprehensibility 45 (7.4) 42.2 (9.1) 48.8 (7.2) 44.2 (8.3) 47.4 (9)

Manageability 34.5 (6) 35 (4.2) 39.3 (6.4) 37.4 (5.4) 37.5 (4.5)

Meaningfulness 38.2 (6.7) 37 (5.5) 38.7 (6.8) 40.9 (6.9) 40.3 (6.9)

IES total a,c 20 (9.6) 21 (16.9) 21 (7.2) 20 (13) 20 (13)

Intrusion 10 (3.3) 8.5 (4.5) 7 (3.8) 9 (6.1) 9 (6.1)

Avoidance 11.3 (4.7) 11 (5.9) 13.8 (5.2) 11.1 (7.4) 11.1 (7.4)

GHQ total a,c 9.9 (4.7) 9.4 (5.2) 12 (4) 14 (8.8) 14 (8.6)

a Significant main effect based on Bonferroni corrected alpha level of 0.003.

b Significant difference between medics and nurses, p , 0.05 level.

c Significant difference between psychologists and medics, p , 0.05 level.

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and Avoidance symptoms seem to predict psychological distress (Witteveen

et al., 2010; Rasmussen et al., 2010; Lavie et al., 1998). In addition, it

seems that the capacity to attribute sense and coherence to uncertainty

and political and military violence promotes helpers’ sense of efficacy

and power. In turn, this is likely to favour phenomena such as PTG as

well as enhancing the helpers’ well-being and quality of life (Barber,

2008; Shamai and Ron, 2008; Motzer and Stewart, 1996). In fact, both

Gazan and West Bank helpers report a very strong sense of coherence

and moderate traumatic symptoms in terms of both Intrusion and Avoidance.

Both Gazan and West Bank groups scored particularly highly on

the comprehensibility subscale of SOC-29 (the extent to which the individual

rates stimuli from his external and internal environments to be

structured, explicable and predictable). In addition, SOC seems to

promote positive adjustment to traumatic events and to moderate

psychological distress and intrusion of traumatic memories of extreme warrelated

events, both in a post-traumatic context (West Bank) and in an

environment affected by permanent and severe conditions of violence

(Gaza Strip).

Figure 3. Results of Mediation Analysis: IES to GHQ mediated by SOC.

Table 6 Main and interaction (moderation) effects of IES and SOC on GHQ

Dependent variable: GHQ Beta* F p

IES 0.55 43.44 ,0.001

SOC 0.17 4.22 ,0.05

IES * SOC 0.14 4.66 ,0.05

* Standardised coefficients were computed by standardising all variables involved in the analysis.

R squared ¼ 0.389 (adjusted R squared ¼ 0.369).

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No differences were found between Gazan and West Bank subgroups, and

no gender differences emerged in either of the subgroups. The former finding

is quite surprising given that theGazan helpers had been far more exposed to

traumatic events than their counterparts in the West Bank. Interestingly,

sense of coherence appears to play a key role in regulating the effects of traumatic

impact in both groups. In fact, all the professionals report a positive

level of psychological well-being and a strong sense of coherence.

Differences as a function of occupation indicate greater psychological

vulnerability on the part of helpers engaged in psychological work (psychologists

and social workers) compared to medical personnel and counsellors.

Conclusions, limitations and future directions

The interesting preliminary findings of this study may have some useful

implications, which we discuss in this section, for helpers operating in contexts

of war and/or military and political violence. However, given the

exploratory nature or our work, we cannot draw definitive conclusions or

over-generalise from our findings. In the first place, although Palestinian

helpers operate in a dangerous environment in which they are constantly

exposed to extreme and even life-threatening events, it appears that their

social context enables them to make sense of their increasingly negative

working conditions and to find meaning and coherence in their everyday

lives (Barber, 2008; Lewin, 1948). The capacity of context to attribute

sense and coherence to conditions of uncertainty and political and military

violence promotes the helpers’ personal growth and increases their sense of

efficacy and power (potency) (Solomon et al., 1998).

Interesting findings also emerged regarding the differences between the

various categories of professional helpers. In the future, we plan to investigate

this finding in greater depth, to test the hypothesis that different levels

of exposure to traumatic events, educational background/training, income

and social recognition may influence helpers’ SOC and general well-being

and quality of life (Carmel et al., 1991; Cunningham, 2003; Kivima¨ ki et al.,


These preliminary results suggest that there may be merit in extending

the focus of future research to examine the well-being of civilian populations

in war contexts. Specifically, personal involvement in activism, societal

growth and political and religious life may contribute to maintaining

a strong sense of coherence in individuals, moderating psychological

distress and the impact of trauma and disrupted socio-economical conditions

(Drageset et al., 2008). In fact, both ability to attribute sense to uncertain

conditions and sense of coherence favour positive individual

adjustment to trauma, in situations of acute trauma such as Gaza as well

as in post-traumatic scenarios such as the West Bank (Hobfoll et al.,

2012; Almedom, 2005).

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Turning now to the practical implications of our study, first, the particular

socio-political context, as well as the living and working conditions affecting

Palestinian helpers should guide the definition of effective and efficient

specific recruitment, training and intervention models, which could also be

appropriate for professionals training and operating in other ‘permanent

crisis’ contexts (Giacaman et al., 2011; Al-Krenawi et al., 2007). Scarce

economic resources and long-term social and political issues have created

a deeply divided and fragmented society that indicate possible strategies

for promoting competence and professional well-being in Palestinian

social workers. In our view, the need for high-quality training cannot be satisfied

using ‘standard’ and ‘Western-informed’models (Giacaman et al., 2011;

Al-Krenawi and Graham, 2000), which provide empirical evidence and

methodological rigour but do not cater for the specific need of Palestinian

helpers to construct meaning and attribute coherence to the permanent

uncertainty to which both they and their clients are constantly exposed

(Al-Krenawi et al., 2007). The key lesson to be learnt from this research is

the need to provide training that is in line with international standards but

also promotes local and culturally sensitive knowledge and competencies,

so as to raise the helpers’ own levels of self-esteem and self-determination

(Veronese et al., 2011). Action research and participative training models

should thus be used to guide the agenda of the institutions in charge of

public health and highest education (Razer et al., 2009; Al-Krenawi et al.,

2007). In a context of social trauma, it is critical that the intervention

models and instruments deployed encourage maximum participation, be

inclusive, offer the opportunity to construct meaning and enhance the

competence of helpers already operating in the field.

Due to the small sample size and the cross-sectional nature of the study,

we cannot generalise our findings. In addition, quantitative data do not

enable us to describe in detail helpers’ strategies for dealing with traumatic

events. In the future, we intend to work with a larger sample and to conduct

qualitative in-depth interviews and focus groups to analyse the helpers’ idea

of well-being.


The first author’s work was funded by the FSE ‘Dote Ricercatore’, a

programme of the Lombardy Region, Italy.


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