The Words That Heal - How Psychoanalysis Helps Refugees and Immigrants Process Trauma

Gloria Blanco

Psychoanalysis is not just a theoretical and clinical practice but can also as a social tool to understand and help heal social realities such as COVID outbreaks, wars, displacement, and various social crises in our world. However, not many people in the community are aware of how psychoanalysis can help them. Therefore, it is part of our responsibility as analysts to reach out to the community and use our knowledge to bring help, education, and understanding to those who need it most.

While our practice has been used to help people process trauma for a long time, the idea of applying this treatment to the social realities of our world is relatively new. In recent years, there has been an increase in research and social programs in different psychoanalytical societies, including those from the International Psychoanalytical Association (IPA). Some of these programs include:

• IPA in the Humanitarian Field Committee 

• IPA United Nations Sub-Committee

• IPA, Migration & Refugees Sub-Committee 

• IPA, Psychoanalysts Emigration and Relocation Committee 

• Australia: Crisis and Responders Outreach (CARO)

• Venezuela: Caracas Psychoanalytical Society. Community Psychoanalytic Service (SAPC). Low-cost psychoanalytic service to the community.

• Italy: Italian Psychoanalytic Society: work with refugees in reception camps (PER).

• Japan: Mourning in relation to WW 2

• Peru. Peruvian Psychoanalytic Society: Psychologies with you

• South Africa – working with groups investigating the intergenerational transmission of trauma around Apartheid.

We believe it is our duty, ethical and professional obligation to apply our knowledge of psychoanalysis to help those in need. For refugees and asylum seekers who have undergone significant trauma and upheaval, the psychoanalytic approach can be a valuable tool in facilitating their adaptation to their new life, culture, and language. By exploring their unconscious minds and past experiences, they can gain insight into their current thoughts, feelings, and behaviours, which can help them better understand their reactions to the challenges they face.

It is important to understand the connection between our clinical work and social realities. I will provide an example of this connection through the case of a political persecution survivor that I would like to present today.

The Path to healing: An Introduction to the clinical Case.

Before presenting this clinical case, I want to emphasize that I took all necessary precautions

to protect my patient's confidentiality and privacy. As such, I obtained written consent from

my patient to present his case in this essay and made changes to the clinical material to ensure his identity remains confidential and to avoid any potential harm to our therapeutic relationship. I know it is crucial to protect the dignity of my patients in any clinical case presentation, and I took all necessary precautions to do so.

In 2013, I started my analytical training at the Caracas Psychoanalytic Society. For those who may not know, Venezuela is a country in South America, rich in natural and economic resources, located near the Caribbean. During that time, I had the opportunity to work as a psychoanalyst with patients who had been politically persecuted by the Venezuelan government and sought asylum for the same reason.

Let me introduce a little of the social political context during that time, between 2013- 2015.

Venezuela experienced a significant decline in its political and social situation. The country was plagued by high levels of inflation, food and medicine shortages, and widespread corruption. These issues were compounded by political instability, including protests and violence, as well as restrictions on freedom of speech and the press. The country's shift towards communism can be traced back to the late President Hugo Chávez's communist policies, which were continued by his successor, Nicolás Maduro. The government's control over the economy, coupled with the mismanagement of resources, led to the country's current state of economic crisis. 

I mentioned this because understanding the social political context in the country will allow us to understand the case presented in this paper. 

In 2013, I started working with a patient that I will call him F, for Freedom. Freedom is from Venezuela. His father and mother were immigrant, because of this, he always felt like an immigrant in his own country. F suffered sexual abuse in his early years. He felt his mother was unable to show consistent care toward him. My patient was a man of good economic standing, a successful businessperson.

The reason for the consultation at the beginning was a conflict with his partner, and he wanted to know whether he wanted to continue the relationship with her at the time. 

F and I started our analytical work four times a week. He would come to the consultation room, and we would work together to understand the roots of his problems. In 2015, one day he missed a session, which was unusual for him. At first, I tried to understand what else his absence was saying about him as a possible unconscious acting out. The next day I saw on the news that some companies were being looted and taken from their owners by government forces, which I thought could have affected Freedom. He did not come to that day’s session either. On the third scheduled session of the week, I saw widespread reports about companies that were being taken over by the government. At that point, after missing three sessions, I sent him a text message saying: “Are you OK?” immediately afterwards, he answered telling me if he can call me on Skype, and I responded: “yes, you can.” F said, he had fled the country clandestinely. He was suffering from severe anxiety, and his ability to think was almost blocked. He just wanted to get out and be safe, and he said that he was terrified. I must confess that I was too.

As his analyst, I experienced a countertransference reaction to the patient's fear while also being aware of the impact of external realities on our therapeutic relationship and my daily life. The patient's political persecution raised concerns about confidentiality and the potential complications this could bring to our work. The government's actions, such as expropriations, contributed to a climate of scarcity, unrest, and violence in the country, which had a significant impact on our sessions and on the reality in which I work and live. These issues affected not only my work with this Freedom but also with my other patients and my daily life. 

In the course of the crisis, my task at the beginning was to determine whether he was in a safe country and environment, without disclosing the exact location. Unfortunately, at the time, he thought he had insufficient access to resources, which made it difficult for F to support himself. In light of this humanitarian situation and considering that he is my patient, I had thought about exempting him from any fees. However, during the session, F realised he had emotional and economical support to face the crisis and continue with his sessions. After some time, F began to process his traumatic experience, starting with original interfamilial trauma (between his father and mother’s families) when they were forced to escape from countries where their lives were at risk, similarly to what F was experiencing. Throughout this period, F revealed that his experience with the government became an unconscious emotional trigger to his childhood abuse, during which he felt violated and stripped of his innocence. This trauma was re-lived through the government's attack on his company, which felt like another violation of his internal world. During our sessions, we worked together to find ways for him to protect himself from further abuse or violence.

Additionally, for F these situations were not just a matter of life or death in the external reality, but they also triggered early death anxieties in his psyche, which were reactivated by experiences such as the ones he went through under the Venezuelan government. It is important to know how an active listening approach helped me understand F's experience from his perspective. 

The goal of active listening was for me to understand how F perceived and experienced his inner world at the moment. In our work together, I listened closely to what F said to me and reflected back what I understood, in order to help him understand himself better. For example, if F said: "I feel like my life is falling apart around me," I respond “What does that mean for you F? Or can you explain that better to me in order to understand what that means for you?” In our sessions together, we explored how this traumatic experience affected his psyche. He said that after this incident took place; his life seemed to be over. He also told me that when we talked about these issues during our sessions together it helped him feel less alone because someone else understood what happened; moreover, this made him feel better about himself because now F knew that someone else had listened and understood.

Through the therapeutic relationship with F, the process of analysis and transference enabled him to explore and work through unconscious conflicts related to his past traumas. Through my attentive listening, F was able to gradually elaborate on his relationship with his mother, which had been marked by a sense of not being fully seen or heard. By bringing these buried experiences to conscious awareness, F was able to integrate previously split-off parts of his psyche and achieve a sense of wholeness and self-understanding. The analytical process helped F reframe his experiences and develop new perspectives, promoting healing and supporting the development of a sense of self. Currently, Freedom is once again a businessman in the country where he resides.

The words in the sessions allowed F to speak, heal and express freely and openly, what the family and the government did not give him. He was able talk without fear of being punished, criticized, or judged by others. F could explore his inner world and confront the unconscious conflicts that had previously been repressed or denied.

I will address Winnicott (1958) "The Capacity to be alone" and his concept of the "holding environment". This technical concept is also relevant to understanding and addressing trauma in refugees and immigrants and was an important knowledge in my work with F.

Winnicott believed that for a patient to develop the capacity to be alone, they need to feel safe and protected in the relationship with their analyst. This is achieved through the creation of a containing and emotionally secure environment in which the patient can explore their feelings and thoughts without feeling judged or rejected. However, for F, during his experience of political persecution, these capacities were disrupted because he could not feel safe, especially at the beginning of our online connections after the event. Sometimes he said: “Dr I am very scared to talk. What if your computer is being monitored? What if the government can listen to our conversations? What F said had a degree of possible truth. We didn't know if we were being monitored, but even though he avoided talking about certain things at that moment, as his analyst, I continued to provide a holding environment that maintained a safe space and frame in our work. 

This allowed F to recover his capacity to be alone during the time of crisis. I brought a safe presence for him to think, heal, talk, and be contained, which helped him to develop the capacity to be alone.

This case at the moment was a transformative experience that has impacted how I think in my work as a future psychoanalyst. Collaborating with my supervisor was a great learning experience as I began to understand both the theory and applied clinical and psychoanalytical techniques. My patient, supervisor, and I found challenges during the sessions due to the ongoing social-political situation in Venezuela. This was evident during transference, countertransference, container-contained position, and projecting identifications. It was difficult; however, it provided me with a lot of learning opportunities and analytical questions to work on and to share today.

Similar to this case, many analysts and candidates from the Caracas Psychoanalytic Society had during moments of dictatorship. This led the Caracas Psychoanalytic Society to create events so that we could deal with the country's situation and our patients. Additionally, many analysts provided free therapy to young political prisoners who were tortured for participating in protests against the dictatorship. 

This is an example of how the country's situation reached our consulting rooms, and how we then went out into the community to help to cope and heal with a dictatorship situation.

HOPE

For me, analytical work is a work of hope. I pose the question, isn't seeking help an act of hope in itself? The act of seeking help is an act of believing that something can be done with what one feels and what causes suffering. This belief is shared by both the patient and the analyst, although some analysts may not recognize it. The analysts does not direct the cure or expect anything from the patient, therefore, analytical work can be seen as a source of hope for both parties involved in the therapeutic process.

In psychoanalysis, I relate the concept of hope not from a religious standpoint, but rather in relation to Klein's concept of the internalized good object. Both concepts involve a positive orientation towards the future and the search for something better.

During the analytical process, we also understand these internalized good objects, allow patients to continue the analysis. In the case of F, it is evident in my work with him that the resilience and the good object internalised in him were required to overcome the challenges of the traumatic events experienced in his childhood and later in his adult life. Therefore, I believe that hope and the internalized good object play a significant role in the F’s psychoanalytic process.

By embracing hope as a guiding principle, psychoanalysis offers a tool for healing and growth, even in the face of adversity. Freedom and I continue to work together, both in free countries

REFERENCES

- Abreu M., Carozza M., Barbera C., & Herrera A. (2020). Un proyecto Educativo Asistencial del Servicio de Atención Psicoanalítica a la Comunidad.

- Costa; M.P. (2020). Psicólogos Contigo. Congreso online de la API en la Comunidad.

- Psicoanálisis más allá del diván. Webinar. https://youtube.be/-k2t3oYeYTg

- IPA (2017) IPA Humanitarian Field Committed. Retrieved May 30, 2023 from Website: https://www.ipa.world/ipa/en/Committees_New/IPAINHUMORGS/CommitteeMaster.aspx

- IPA (2018). Report of the Confidentiality Committed. Retrieved May 30, 2023 from Website: https://www.ipa.world/IPA_DOCS/Report%20of%20the%20IPA%20Confidentiality%20Committee%20(English).pdf

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- PRENGLER, A. (2019). Refugees and Immigrants: How Can Psychoanalysis Contribute? [WEBINAR SEPT 29, 2019] Retrieved May 21, 2023 from Website: https://www.ipa.world/

- Winnicott, D. W. (1958). The Capacity to be alone. International Journal of Psychoanalysis, 39, 416-420

- Winnicott, D. W. (1960). The theory of the parent-infant relationship. International Journal of Psychoanalysis, 41, 585-595

- Winnicott, D. W. (1965). The Maturational Processes and the Facilitating. Environment: Studies in the Theory of emotional Development. New York: International Universities Press