Caroline Sehon, MD, FABP, As Published in the American Psychoanalytic Association (APsA)

Psychoanalytic intervention can be challenging in the best of times, but during wartime it can be particularly so. When the psychoanalytic community steps up, it can bring support, relief, and a reminder that those living on the frontline are not alone. An online global psychoanalytic forum can offer understanding, containment, and group solidarity to therapists and analysts impacted by war trauma. A monthly Zoom Town Hall offered to clinicians worldwide by the International Psychotherapy Institute (IPI) at the start of the Covid-19 pandemic in 2020 increased to twice-weekly in February of this year to address the Russo-Ukrainian War. With the Russian invasion of Ukraine in its fourth month at time of writing (June 2022), the Town Halls continue meeting open-endedly.

The Town Hall welcomes therapists and analysts from around the world, especially those who are directly affected in Ukraine and Russia. Other attending clinicians call in from Canada, Estonia, Italy, Lithuania, Poland, the Czech Republic, South Africa, the United Kingdom, and the United States. The group comprises individuals who began attending the Town Halls with the start of Covid-19, as well as others who joined after the Russian invasion of Ukraine began. Many participants attend regularly, whereas others attend variably, as their personal circumstances permit. Ukrainian colleagues often miss the Town Halls, leaving the rest to wonder if they (1) have been killed, (2) are seeking refuge in their basements, (3) are escaping to safer zones in or outside Ukraine, (4) are avoiding frightening encounters in the Town Hall with their Russian colleagues, or (5) are seeking solace with loved ones. Simultaneous Russian–English and Ukrainian–English translation is supported by interpreters. Tatiana Onikova, a Prague based colleague and Town Hall co-host, distributed the IPI Town Hall flyer beyond IPI's global email list to therapists and analysts throughout Ukraine, Russia, and Eastern Europe.

The group had 150-215 participants immediately after Russia's invasion and for the first several weeks, and then diminished to an average of 80-150 participants for the next several weeks. It gradually decreased to approximately 25-30 attending regularly by the fourth month. The group considers the possible explanations for this gradual attrition to include participants’ accessing alternate local supports, feelings of saturation and need for respite, and acculturation in the country to which they evacuated.

As IPI director and Town Hall moderator, I aim to cultivate a meaning-making conversation where we listen to unconscious themes and associative links, decode non-verbal communications, and analyze silences; share dreams and drawings, to which participants freely associate; and address transference–countertransference. A distance-learning environment co-founded in 1994 by David Scharff and Jill Savege Scharff, IPI employs its Group Affective Model (GAM) at conferences and certificate training programs to examine unconscious resonances of psychoanalytic concepts expressed within groups. IPI was in a singular position to bring a psychoanalytic response to clinicians who are, in a sense, on the frontlines of this world-shaking conflict. And although IPI Town Halls are not GAM groups, we adapt psychoanalytic listening and group interpretation principles in support of “thinking under fire” during wartime. I felt compelled to offer these wartime global conversations, bearing witness to colleagues who were psychically hemorrhaging on the fault lines between life and death.

When the psychoanalytic community steps up, it can bring support, relief, and a reminder that those living on the frontline are not alone.

Navigating the Group Analytic Journey

As a wartime initiative, the Town Halls served initially as an acute crisis intervention. Heartbreaking stories flooded the meetings as traumatized clinicians express their helplessness, hopelessness, and life-and-death anxieties. They experienced imploding under the strain of uncertainties and terrors. Would their loved ones in Kyiv survive? Could their colleagues’ families escape from Ukraine? Would supervisors find refuge? When would the war ever end? The war shears personal and professional identities. Russians expressed shame and guilt over their country's actions. Commonly, Russian participants voiced intense marital conflicts or intergenerational tensions arising from differences of viewpoints about the war. They described painful feelings of isolation and loneliness when their spouse or parent had voiced an unshakeable pro-war stance. A Ukrainian participant described an incident in which actors at his amateur theater group entered into a warring conversation due to the diversity of viewpoints held about the war on Ukraine, with some actors voicing pro-war sentiments. Many of the participants say that the Town Hall is their only safe refuge.

Participants in Russia and Ukraine speak about feeling plagued by an ever-present war upon their minds, forced to defend against such horrific anxieties with denial, depersonalization, derealization, and deadening of their thinking capacities when alone, with families, or with patients. One US participant, who spent many childhood years in a Latin American country under a military dictatorship, shared a recent nightmare of being held hostage. In turn, another woman living in Russia associated to the dream—tears flooding her face, she described a constant feeling of being raped in a room with no escape. Upon noticing that she appeared to be doodling, I invited her to show her artwork. She held up the image (shown here). Many participants remained mute throughout, though their faces wore palpable distress. They appeared shell-shocked, their tears revealing their torment. Several persons extended a psychoanalytic helping hand for holding and containment. Some described firsthand and intergenerational war trauma histories. Others empathized and identified with those most traumatized.

Early on, participants bonded by their shared respect for psychoanalytic “thinking under fire” (a wartime phrase coined by Wilfred Bion), which served to unite us despite our varied languages and cultural roots. Resiliency was evident. Several persons who were initially shy became increasingly able to speak out as time went on. Russian participants voiced their freedom at being able to share sentiments and perspectives in a safe territory, which one person called a “humanitarian corridor.” For some, these Town Halls offered the only opportunity to speak freely without fear of reprisal and incarceration. Western participants from South Africa, the United States, and the United Kingdom often voiced guilt over their freedoms. For example, one American participant described her freedom to “open and close the door” to media accounts of the Russian invasion of Ukraine. She told us that it was important for her to “keep the door open (in her mind)” by participating in the Town Halls, so as to confront the atrocities that are ever-present in the lives of Ukrainians and Russians and to support those who have been robbed of such freedoms. One Western participant voiced his privilege to stay in contact with those in Ukraine and Russia as media attention recedes.

After a few weeks, I wondered aloud whether the expressions of gratitude were connected to their dependency on the Town Halls as a symbolic lifeline and their fear of the group ending, perhaps echoing their larger worry that the world may lose interest and turn away to leave Ukrainians, Russians, and Eastern Europeans to fend for themselves. I reaffirmed that IPI would continue offering these meetings open-endedly. These interventions may have catalyzed a breakthrough for the group, deepening investigations of analytic themes because of enhanced trust in the setting.

For example, a few Ukrainians described their fear that their Russian colleagues in the Town Halls would be unable to tolerate their voiced outrage at the Russians for instigating the war, or their fierce conviction that Ukraine would ultimately prevail. In one Town Hall meeting, a kind of standoff emerged between the Ukrainian and Russian interpreters: a Ukrainian participant began speaking in Russian whereupon both interpreters began translating into English at almost the same time. Consequently, both interpreters’ voices drowned out each other, leading to a confusing cacophony of sounds that created momentary chaos within the group. At this moment, I asked the interpreters to pause to allow the group to analyze the unconscious dynamics that might be at play. Then the Ukrainian interpreter recognized that she was overcome by the urge to help her fellow citizen when she later realized that it was not her remit to translate when Russian was being spoken. A mother-baby pair from Eastern Europe join regularly—the mother recently remarked that she noticed a direct correlation between the severity of her daughter's skin condition (atopic dermatitis) and their joint attendance; her baby's skin clears up when her mother attends with her and flares up if the mother misses. This compelling example has been riveting to the participants as a testament to the power of metabolizing traumatic affects lest they become deposited in the body in the current or next generation.