The big issue: Hope in the shadow of conflict
Therapy Today, May 2022

Faced with the hour-by-hour news reports, the video clips, interviews and photographs of what is currently happening in Ukraine, it is hardly surprising that counsellors and psychotherapists should ask themselves – question even – what their skills, knowledge and understanding can bring to the plight of these people. What can the counselling professions do in the face of global emergencies such as these?

For people in the UK, Russia’s invasion of Ukraine, the news coverage of millions of refugees fleeing across Europe in scenarios reminiscent of World War II and the revived threat of nuclear and chemical warfare will be deeply affecting. They will be impacting on UK practitioners, just like anyone else, individually. And the economic repercussions from the sanctions against Russia will be hitting us all, to some extent, but the poorest and most marginalised will be hit the hardest – people already reeling from the economic consequences of COVID and rising energy bills. We live indeed in troubled times.

So what, if anything, can counsellors do about them? What should they be doing about them? It is human nature to want and need to act, to do something in the face of feelings of powerlessness, fear and empathic sorrow for the victims of these events. But is individual talking therapy much use when the issues that are distressing us are undoubtedly very real? We have good reason to be afraid, even though we are not living through the nightly bombardments; even though the waves of refugees are not yet crossing our borders and seeking our direct help. The poverty that some households in our own country are experiencing is also all too real and will worsen. What can counselling do for angry and frightened people who are choosing between feeding their children, buying them shoes or keeping them warm?

These were the questions that impelled a massively subscribed online conference jointly hosted in late March by Onlinevents and the School of Psychology, University of Roehampton, as a fundraiser for the UN emergency relief fund for Ukraine. More than 1,000 people registered for the event, which brought together leading practitioners and theorists in today’s therapy world, who volunteered their time willingly. The aim was not just to raise money for the appeal (already totalling some £30,700 as we went to press) but also to reboot the conversation about psychotherapy and politics with the urgency it clearly needs; the global turbulence seems unlikely to ramp down in intensity any time soon.

Billed as an ‘Emergency Summit Contributing to Global Peace and Justice’, the conference ran throughout a long, intense day and will, it is hoped, continue to inspire responses from across the profession and raise further funds through the recorded transcripts (see below for links).

Politics in the counselling room?

Dr Orna Guralnik, clinical psychologist, psychoanalyst and therapist in the documentary series Couples Therapy recently shown on BBC2, set the parameters for the day in a hard-hitting interview with conference co-host Mick Cooper, Professor of Counselling Psychology at University of Roehampton. She is very clear that psychology and psychotherapy are by their very definition inherently political, and that it would be dishonest to deny that.

"Therapy theories can be deeply aligned with very reactionary forces, not always with the forces of liberation"

Orna Guralnik

She pointed to the less than honourable history of the psychoanalytic profession in colluding with oppressive regimes: ‘People would like to believe therapy is always aligned with social justice but it isn’t actually true. Therapy theories can be deeply aligned with very reactionary or conservative forces. It’s not always joining with the forces of liberation but it should be. I’d like it to be. [We have to be] honest about the ideologies that underlie our interventions. Who are our stakeholders? When we are working with patients, is what we are imagining is good for us also good for them? Think about the political implications of what we are doing, why we are doing it, who we are aligned with,’ she said.

The misuse of psychiatry in the former USSR to imprison and control dissidents is well known; so too is the employment of psychologists in ‘interrogating’ terrorists in the US. But even in the UK, in the past decade, we have seen psychologists accused of ‘psychocompulsion’ in working with the Department for Work and Pensions and IAPT, reframing unemployment as a personal failure or weakness requiring cognitive behavioural therapy, rather than as a social and economic reality and tragedy.

Psychology and psychoanalytic professionals have the tools to be a force for good, Guralnik said: ‘We have a way when we work therapeutically of opening up a space for conflict to not be too quickly resolved, because when you try to resolve conflict too quickly, usually there’s a winner and a loser, and things collapse into the most violent solution where one oppresses the other.

‘When you create a situation where there is more ability to tolerate distress, uncertainty and difficult affects, and sustain yourself through it so thought can emerge, then you can come up with much better solutions. The best politicians are really good at that. They are not overwhelmed by affect or primitive emotions but can sustain themselves and think long term about big conflicts.

‘And as therapists, we have the tools to do that, that is what we encourage our patients to do – to sit with difficulty and not rush to any forced solution. That is how real solutions that take into account multiple perspectives can come into play.’

And each and every one of us can have an impact, even just by doing it at a local scale, with clients and groups. ‘This has a subversive way of having an impact on the world,’ she said. ‘I think of the Judaic concept of tikkun olam, which means repairing the world one person at a time. It is a non-grandiose, local process of repair that goes on in our offices day by day, under the radar, and through social media and podcasts, influencing by teaching people to think more logically and analytically and refrain from primitive solutions,’ she said.

Nor, in her view, can therapists refuse to engage with politics in their clinical practice; they cannot divorce what they do from the political contexts of their clients’ lives. ‘Worldwide there is a desperate need now for therapists. People know the limit of what they are capable of thinking through and tolerating and they are seeking our advice. I have people contacting me just wanting to talk about what’s happening politically in the US. They have reached the limits of what the regular political system can supply in terms of thinking through how we have reached such an extreme stage of polarisation. They are asking, what do you do about it? There has got to be some kind of psychological dimension to it.’

Honesty and self-reflection

John McLeod, Visiting Professor of Counselling at Abertay University and the Institute for Integrative Counselling and Psychotherapy, Dublin, wasn’t holding back either in his presentation: ‘As citizens of an interconnected world, all of us have responsibility, and opportunity, to do what we can to support victims of war and create more just and ecologically sustainable ways of living together,’ he said. ‘I believe that an appropriate response to the invasion of Ukraine, and all that it represents, would be to acknowledge the part that over-individualised and narrowly focused forms of psychotherapy have played in allowing such a thing to happen. Such a response would entail committing ourselves to developing a therapy that can be used by individuals, families and communities not only to handle depression, anxiety, loss, trauma and relationship difficulties, but also as a space for working on dilemmas, choices and capabilities around what kind of society we want, and what we can do to achieve it.

"Psychotherapy has focused too much on self-contained individualism, and not enough on building communities"

John McLeod

‘We also need to look honestly at ourselves,’ he said. ‘Although psychotherapy has developed many valuable strategies for helping people to handle everyday concerns and the consequences of adverse life events, it has largely ignored the ways that clients and patients may also be troubled by social and political structures and crises. Psychotherapy theory, research and practice has not sufficiently considered active citizenship, solidarity, generativity, mutual aid, truth-telling and wisdom as intended outcomes of therapy. It has focused too much on self-contained individualism and entitlement, and not enough on building communities and tending the more-than-human world. Psychotherapy has functioned – not entirely, but for the most part – as a form of practice whose purpose has been to help individuals in prosperous societies to make the most of the life opportunities afforded by membership of dominant social groups at a time of historically high levels of material plenty. Issues associated with such matters as violence, slavery, militarism, consumerism, corrosion of social capital and political discourse and destruction of the living earth have been addressed only at the margins. Typically, there are few opportunities to consider the relevance of historical and intergenerational processes, or the future world that will be inherited by our children, grandchildren and later generations.’

Asked what the individual counsellor can do now, today, in their work with clients, McLeod urged researchers and practitioners to widen their focus beyond changes in clients’ presenting symptoms as a measure of their effectiveness. ‘Nobody is asking “Does therapy help the client become a better citizen in whatever form of political action makes sense to them? Does therapy help them be more critically conscious and ask difficult questions about the world we live in? Does therapy help them to be more generative in terms of offering something back to society?”’ These are the questions we should be researching as a measure of our impact, he said.

Courtland C Lee, now retired but for more than 40 years a counsellor and counsellor educator in the US and Fellow and Past President of the American Counseling Association, has long argued that counsellors have both a moral and an ethical responsibility to address contemporary political realities in their working practices. ‘We are practising in a diverse world that is underscored by a lot of savage inequalities and injustices,’ he said. ‘The world in general is in crisis. We have issues of racism, challenges towards women and young girls, a worldwide climate crisis, with wildfires, droughts, hurricanes and typhoons, hunger and famine. For the past two years we have been held hostage by the coronavirus. Individually and collectively we have been traumatised in a way we never have before, and what is happening in Ukraine brings this home. What all this means for us as mental health professionals is we cannot continue to do business as usual. We can’t just be person-centred; we have got to be a hell of a lot more in terms of how we approach our work.’

Cultural competency is a journey, not a destination, Lee believes, and his challenge to all practitioners was: ‘Can you go that extra mile?’

But what counsellors seem to find the most challenging of all, he said, is taking up the mantle of the social justice advocate and lobbying to change laws and policies that block equal access to resources that promote mental health and wellbeing and challenge inadequate social support systems. He quoted the US civil rights activist John Lewis, who declared: ‘When you see something that is not right, not fair, not just, say something. Do something about it. Get in trouble. Good trouble.’

"We cannot continue to do business as usual. We can’t just be person-centred; we have to be a hell of a lot more"

Courtland C Lee

John Wilson, Visiting Fellow at York St John University where he researches loss and grief and established one of the first Facebook peer support groups for people bereaved by COVID, reminded practitioners of their roots in humanistic theory and Carl Rogers’ recognition that politics is essentially about power. He quoted Rogers: ‘To me, politics involves the question of where power is located, who makes the choices and decisions, who carries out or reinforces those decisions, and who has the knowledge or data regarding the consequences of those decisions.’¹ And again, on the actualisation process: ‘It is development toward autonomy and away from heteronomy, or control by external forces.’²

Wilson also cited the late Pete Sanders, whose co-edited book Politicising the Person-Centred Approach is a call to political action on the part of all person-centred practitioners: ‘Thinking and feeling, whilst necessary, are not sufficient… Being is not enough – doing completes the picture… it doesn’t seem to matter what we do, as long as our doing remains true to our values, but doing, it would seem, is one of the ways we can reconnect with our experience, each other and the world.’³

In terms of his own work on bereavement, the situation in Ukraine, and the past two years of COVID, Wilson referred to assumptive world theory, developed by the psychiatrist Colin Murray Parkes to explain why we grieve. ‘Like all animals, human beings strive for stasis, the physical and mental state of equilibrium in which we can feel safe and secure. When our body goes out of kilter, we feel that discomfort and try to make things right. Parkes’ assumptive world theory explains our sense of unease when the world we thought we could rely on, that we took for granted, is suddenly and radically changed…

‘Nobody would suggest, from the comfort and safety of the UK, that our grief in any way resembles that of the people in Eastern Europe. We can, however, say with some justification that we have been grieving lost assumptive worlds since COVID-19 came on the scene. Just as we were beginning to feel it was safe to go back in the water, along comes another metaphorical shark. This shattering of our assumptions about the safety of life in Europe is coupled with empathy for the Ukrainians. We identify with the people living very similar lives to ours. We grieve with them and for them and we feel helpless. We struggle to claw back some measure of control with the adding of blue and yellow flags to our social media profiles, with our donations, with our thoughts and prayers.’

An attack on all of us

Sadly, however, while there has been throughout Europe and the US an upswelling of solidarity with the people of Ukraine, it is not all the people in Ukraine who are being offered shelter and a warm welcome in neighbouring countries. Dwight Turner, Course Leader in Humanistic Counselling and Psychotherapy at Brighton University, flagged up the insidious undercurrent of racism that has permeated media reports and Government policies in response to the Ukrainian crisis. He gave examples of media reports expressing shock that such a thing could happen in Europe: clearly, for some commentators, war only happens in north Africa and the Middle East, not in ‘relatively civilised, relatively European’ countries like Ukraine, as one US television reporter put it. ‘The crisis in Ukraine has exposed the racist tendencies in the Western world,’ Turner said. None of the wars currently raging all over the world are ‘somewhere else’; ‘the war in Ukraine is a war on all of us.’

"The crisis in Ukraine has exposed the racist tendencies in the Western world… this war is a war on all of us"

Dwight Turner

He criticised the UK Government for its failure to open its borders to Ukrainian refugees, and powerfully reminded us of reports of black African and Asian nationals pushed to the back of the queues at the border crossings in Ukraine as its people fled before the Russian advance. He also quoted from a paper published in the BMJ, by Simar Bajaj and Fatima Cody Stanford,⁴ in which they identify ‘a systemic devaluing of people from ethnic minority communities’ by countries taking in Ukrainian refugees. Racial trauma, coming on top of war trauma, can only compound the impacts on the African and South Asian refugees also fleeing Ukraine for their lives, Turner pointed out, and he again cited Bajaj and Cody Stanford: ‘The trauma people experience as a result of displacement and conflict is singularly horrific, but it is made all the more harrowing when compounded by racism. The international community has banded together to stand with Ukraine, yet this solidarity is undermined by a deadly legacy of racism. War is not a time to divide the world into the worthy and unworthy, but to recognise our shared humanity and responsibility to protect all alike. The same dignity and empathy must be afforded to every person fleeing conflict, no matter the colour of their skin. We cannot neglect equity in times of conflict. After all, that is when we need it most.’

In the spirit of Ubuntu, ‘We are all defined by our compassion and humanity towards others,’ Turner said. In the words of Mahatma Gandhi: ‘We must not lose faith in humanity. Humanity is an ocean; if a few drops of the ocean are dirty, the ocean does not become dirty.’ The people attending the conference were part of that bigger ocean, Turner said: ‘We are not the dirty parts; we are the ones who actually come out to say, “We support you because this is an attack on all of us”.’

Relatedness

This reminder of our interconnectedness emerged again and again in presentations throughout the day. Another major focus was how psychological and psychoanalytic constructs and theory can help us understand, make sense of, this demonstration of our capacity to brutalise one another, and how and why we can curb those drives and instincts.

Psychiatrist and existential psychotherapist Digby Tantam shared some of his learning from work he did with men accused of brutal and unprovoked killings. His aim was to find ways of understanding the sense the killers made of the murder, so as not to simply dismiss them as evil, demonic, mad or possessed – as non-human: ‘These are all words for people who are in some way inhuman, or in some way outside our understanding of what other people are like; they stretch our knowledge of human behaviour and break it,’ he said. ‘It’s very hard to accept that somebody who is a murderer is a human being; we might be so disgusted by the nature of their murder, the murderous act that they perpetrated, we want to demonise them. But I think in the long run, that’s damaging to our own mental health.’

He used narrative theory to explain how the killers were able to construct explanations for their actions that were logical to them, however warped and illogical they might seem to anyone else. Essentially, we need to be able to make sense of other people’s actions in order to regain, maintain or retain a sense of security, control and safety in our lives, Tantam argued. ‘Until we can do that, these things will seem like something terrible that can enter into us that we can’t predict or avert.’

Existential analyst and psychologist Ernesto Spinelli similarly talked about how his own explorations of existential relatedness have enabled him to manage his feelings of helplessness as he listens to the news from Ukraine. He recalled 1968 and the utter helplessness he felt when, as a young adult, he marched against the Soviet invasion of Czechoslovakia. Today he was, he said, feeling the same anger, shock and sadness, but ‘this time I am not so overwhelmed’. The understanding that we are not fragmented, unconnected subjects but part of a wider, interconnected whole, impacted by the actions of others and impacting them, should not, he argued, engender a warm, fuzzy sense of togetherness in adversity; rather, ‘this existential relatedness demands nothing less than the loss of every individual’s total autonomy. Because of relatedness, no one of us can retain complete control over our own being. And from this view of relatedness, each individual is implicated in the actions carried out by any other individual or group of individuals. There is no longer any clear-cut us and them.’

But this is something that few of us will want willingly to embrace. It is too easy to forget our own part in a situation when we can wholeheartedly blame someone else. ‘It challenges us to look again at the actions we have taken or avoided taking that may have influenced those actions taken by others, which we rightfully respond to with anger and repugnance,’ Spinelli pointed out.

So, in the current situation, for example, it asks us in the West to consider how our failure to challenge the Russian Government when it carried out similar atrocities in Syria and incorporated Crimea contributed to their invasion of Ukraine. ‘All this in no way exculpates Putin and his allies from the atrocities and crimes they continue to inflict. On the contrary, what it does, hopefully, is make us all aware of how relatedness includes us in the narrative, and that in doing so, it might well heighten, not lessen, the sense of anger and sadness and shock we feel so that we will not permit ourselves to allow short-term convenience to blind us so easily, yet again, tomorrow.’

An obvious question is that, if relatedness implicates each of us in all that occurs in the world, then how do we ensure that who we are and what we do is a force for good? To which his answer was simple: ‘Ask yourself, is what I intend to undertake something that I would want another to undertake supposedly for my benefit?’

"Is what I intend to undertake something that I would want another to undertake supposedly for my benefit?"

Ernesto Spinelli

For Paul Gilbert, Professor of Clinical Psychology at the University of Derby, evolutionary psychology, polyvagal theory and his own model of compassion-focused therapy provide a framework for understanding the callous side of humanity and offer practical ways of managing that in ourselves. ‘We have these two different dimensions of our lives: one is compassion, which is sensitivity to suffering in the self and others, but unfortunately, we also have a dark side, which is callousness, when we are insensitive or indifferent to suffering itself and others and have no interest in alleviating or preventing it. The fact of the matter is, very tragically, there are many things that shove us along this dimension that tend to make us callous and turn us off from suffering,’ Gilbert said. In particular, ‘when we become more self-interested, we tend to be more callous’.

Counteracting our callous side

Gilbert talked about ‘controlling hold’ and ‘sharing care’ – the two ends of the spectrum that characterise how humans navigate conflicts over resources, and the two states or types of mind that enable us to take either route. Human beings are nasty, he said; we have evolved that way, like all animals, through the innate drive to survive. But we also have the ability to foster compassion – to generate a compassionate mind, to apply sharing care rather than controlling hold, by even quite simple actions that trigger the vagal nerve and lead to the production of the ‘happy hormone’, oxytocin. Over the past 500 years, humankind has got a lot better at counteracting its callous side – not just at an individual level but most crucially in how we treat each other, and other species, at community, national and global levels. We have produced compassionate leaders like Nelson Mandela, the Dalai Lama, and now, he said, Ukraine’s President Volodymyr Zelensky.

‘When you become aware of these elements within you that can get up to mischief, then you can begin to differentiate those elements… You recognise that you are made up of many potentials; you are a rainbow. Then you learn how to tolerate your anxiety or tolerate your anger and when you can tolerate, you can begin to integrate and that produces transformation,’ he said.

"Wherever people have lost that meaningful centre, we need to help them reconnect and integrate"

Emmy van Deurzen

Rising from the crisis

Emmy van Deurzen, Professor of Psychology and Psychotherapy, writer, and co-founder and principal of the Existential Academy, has her own experiences to draw on when speaking about war, deracination, migration and what therapy can do to help people rebuild shattered lives in a transformed world. She was born and grew up in the Netherlands in the period immediately following World War II. Her parents barely survived the Nazi invasion and occupation, and their privations and their impact coloured her childhood. And, having settled and established her life and career in England, in 2016 she, and thousands of other EU citizens, found themselves threatened with deportation when the UK voted to leave the European Union.

In her presentation, she described vividly the threat to a person’s sense of self to have their life upturned and ripped apart by political actions beyond their control; to find themselves at risk of losing all they have – materially and emotionally – and seemingly regarded as an alien in what they believed was their chosen homeland. ‘What happened to the EU citizens is proof if we need it that mental health problems are created by society, by the state, by political situations, by people being deprived of their identity and losing their North Star,’ she said. She also drew on wider research with refugees to talk about how displaced people rebuild their shattered lives by having ‘air roots, rather than roots in the earth, because that’s the only way you can find your bearings again. So in catastrophes, we need to learn to put our roots into the stars, the moon, the sun, and the planets who will come with us wherever we go.’

Van Deurzen quoted the words of a Ukrainian colleague, Anna Lelyk, President of the Ukrainian Association of Consultancy and Therapy, from her Facebook page. Lelyk was angry with Western therapists advising her how to cope with living in a state of siege and bombardment by meditating, aromatherapy and finding inner peace: ‘Nonsense, when you are sitting in a bombardment, just be yourself. Panic, be angry, cry, relieve and express your emotions so you won’t have to suppress them and have PTSD later on,’ she wrote.

Van Deurzen’s advice in such crises is: ‘Live… War is also life; it’s horrible, perverted, inhuman, but it’s still your life, so make something of it. And do read the news. The news is everything. It gives you an illusion of control. And stay in touch with as many loved ones as you can. Rebuild that chain of connectivity; support each other. And, finally, do your best to stay alive. Around you is your spirit, the things that inspire you, that give you purpose; around you are all the things you have already done in your life that you can count on. You as a person are still able to take action. Your family and peers are still around you, your culture and society are still around you, nature is always reliably there.

‘We as therapists can help people to find this new strength in themselves, this pride in their new identity as having withstood these very trying times and tribulations. And from that, people realise that they can make meaning, they can be efficient, they do have values, they can have self-worth and purpose,’ she said.

This, then, is the role of the therapist: to help their client find meaning in their situation, find their inner core of strength and build on that, rather than dwelling on the tragedy of the past. ‘As therapists, we are the guardians of the art of living and that is about weaving together the strands of life into a meaningful whole that keeps us safe. Wherever people have lost that meaningful centre, we need to help them reconnect and integrate. Do what you can. Live deliberately. Seek truth. Breathe and live to the full.’