Threads from the labyrinth: therapy with survivors of war and political oppression

Abstract

War and political atrocity are endemic, and the denial of what has befallen survivors who become refugees has both therapeutic and human rights dimensions. The work described in this article considers the psychological and political aspects of the suppression of memory and culture and how psychotherapy engages with these processes. Narrative, in its customary form as the creation of stories, is discussed as one of the ways of enabling survivors to be given a voice that allows them to process events of atrocity, displacement and exile. The usefulness of psychoanalytic ideas and their integration with systemic practice is demonstrated. The interplay between difficult psychotherapeutic material, the patient or family and the therapist is shown and the use of supervision noted. The discussion is exemplified with descriptions of therapeutic work with individuals, families and small groups. The thinking that emerges is applicable not only to work with survivors but has general implications for systemic work in general as it struggles with its contemporary identity.The work described in this article was carried out at the Medical Foundation for the Care of Victims of Torture, London, where I work as a psychotherapist with families, couples, individuals and groups. The Medical Foundation offers holistic psychosocial help to survivors of torture and organized violence. The majority of people who seek our help are refugees and asylum seekers, although we also work with former prisoners of war, aid workers and travellers who have been abducted.

Constructions of emotional impact, risk and meaning among practitioners working with asylum seekers and refugees

“…In the first extract, the practitioner's discourse of the world as an ‘unsafe place’ mirrors the level of impact that clinical work of this nature has on a professional's world view, a position that is supported by research (Ben‐Porat & Itzhaky, ; Munday, ), which shows that ‘war and organised violence not only break into the minds of people exposed to atrocity but also deeply into the consciousness of practitioners who work with survivors (Woodcock, p. 140). In a similar manner, in the second extract the practitioner draws upon the discourse of vicarious traumatisation which brings into the foreground the risk of a professional becoming emotionally and psychologically damaged by their clients’ extreme experiences.…”

“…The findings of this study highlight that practitioners who work with refugee clients who have survived unusual traumatic experiences such as war, torture and violence are at risk of becoming traumatised by their clients’ material. More specifically, the impact of such demanding work extends beyond the context of professional practice, to the relationship with oneself (Woodcock, ), as it entails the danger of losing connection with oneself and of experiencing psychological harm. The importance of being aware of one's emotional resources and strength, when working with individuals with highly traumatic experiences, is a matter that is hugely discussed in the literature (Huggard, ) and which emphasises the need for proper and adequate professional supervision.…”

Containment, curiosity and consultation: an exploration of theory and process in individual systemic psychotherapy with an adult survivor of trauma

“…I was distressed to think about the horrific actions inflicted on a small child, but I interpreted the reactions not only as my own reactions, but also as projections. The transferential process helped me to understand the interior history of my client (Woodcock, 2001). It was a powerful communication in which I took some of her feelings and experienced them as though they were my own (Garland, 1995).…”

“…Subsequently she remembered her father leaving her in the room, perhaps overnight. Over the next two years the story, forgotten until therapy, was revisited and elaborated as new fragments were recalled in the way that Woodcock describes: ‘pathways that may be followed or ignored or returned to later.’ (Woodcock, 2001, p.137). She remembered money being handed over, her lying on a table and perhaps being drugged in some way so that she lost consciousness.…”

Refugee families: issues of systemic supervision

“…The therapists' systems include the actual services and institutions where they are employed, along with their policies and practices, the ideologies of the aid industry, professional affiliations, therapeutic orientation, as well as their own personal background and history. Finally, systemic approaches are useful in working with refugees because they can sharpen the professionals' epistemological sensitivity and inform them about the interaction of the various narratives that each one of these systems uses to express itself (Papadopoulos, 1999a;Sveaass and Reichelt, 2001;Woodcock, 2001). …”