Facing the Realities of War With Our Clients, for Ourselves

As most people now know, Russia and Ukraine are culturally interwoven. Many families have both Ukrainian and Russian roots and family members, and relationships of every kind extend across the border. I see how these shared cultural roots manifest in relationships, career choices, and personal identities through my patients.

I have participated in several programs on conducting therapy in times of national threat and war through the International Psychotherapy School in Moscow, run by a Russian colleague. I count many Russians and Ukrainians among my colleagues, students, and patients. This, of course, means that I encounter a wide variety of experiences from people grappling with the current war.

Most of them, both Russians and Ukrainians, are strongly against the invasion of Ukraine. Many Russians have left Russia or moved to be further from the conflictual borders, while many of my Ukrainian colleagues are simply focused on their survival.

We hear from them in a twice-weekly town hall meeting: a virtual gathering intended to be an emotional bridge conducted by a colleague at the International Psychotherapy Institute. These meetings let our colleagues talk with each other, share their harrowing experiences, and communicate with each other at a time when so many are cut off from families, loved ones, and colleagues.

Working clinically with people in danger or whose families are in danger requires a shift in perspective. Clinicians working with people in active trauma must adjust their focus — and therapeutic technique — to be supportive of their clients’ efforts to survive and to distance themselves from immediate danger.

Mental health therapists must think of themselves as first responders in situations like this. It’s akin to the work we did in the wake of 9/11 or that our military mental health colleagues have always had to do in working with troops and their families. Survival skills and concerns come first — and this is not the time for digging into the deep past.

War and Earl Hopper's “Social Unconscious”

As we rush to help those most affected by the war, we must also take stock of our own experiences at this moment in history. Heightened risk — or at the very least, heightened awareness — is in the background of our daily lives now, and questions about our futures loom large:

“What if there is a nuclear war?”

“What will happen to my neighborhood when Ukrainian refugees arrive?”

“How can I support the people in my life who have Ukrainian or Russian roots?”

The awareness of war is now with us all.

I find it helpful to frame these thoughts through the lens of “the social unconscious,” developed by Earl Hopper (2003). He described how each of us carries a set of experiences shared with those in our culture and our daily social life.

Some of these are bred into us from the beginning of life – cultural assumptions, religion, moral structures — while other concepts come to us through current events like presidential campaigns or current social justice issues. Still, other concepts arrive with urgency: in the wake of a terrorist attack or, as now, a war that seems suddenly closer than we wish.

When that happens, these events, even ones we think do not touch us immediately, require a constant, low-level awareness. All of us who were adults at the time of 9/11 can remember where we were when we learned of the planes hitting the World Trade Center.

For those of us who were alive when John F. Kennedy was killed, we can still remember where we were when we heard the news. (I was in medical school, in a microbiology class, when someone ran in to tell the professor, who held the news until he finished the lecture.)

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Other examples of traumatic moments in the social unconscious might include the Vietnam War, which compelled me to move and join the Public Health Service to avoid the draft. That war, while very much a global conflict, was with me as a personal experience — in a way shared with so many of my generation.

These events — 9/11, the assassination of JFK, the Vietnam War, and now living through the pandemic — are among the most important social events of my life. The Russian-Ukrainian war is likely to rank among them.

To be clear: feelings about the war will vary widely. Because of my involvement with Russian and Ukrainian colleagues, the war feels real and close to me. For some, the war may still feel distant; for those with family contacts or who have emigrated from Russia or Ukraine, the Baltic countries, or Eastern Europe, the war will have an immediacy.

A competent mental health professional must be aware of their clients’ real-time sense of threat and their own threat level.

Regardless of how intimately the war affects us, it is now a part of the background of our lives and the lives of our clients. Through the awareness of war, a thread of commonality runs through us. To one degree or another, it matters to us, and it matters to our patients.

We all carry an awareness of world events, a sense of danger or safety, and a degree of willingness to engage with these forces in our daily lives. We must remain aware of the effect the war has: not just in the work we do with our patients but also in our own lives.