“Help for Helpers” project

Essay1 by Natalia Bielova

(Psychoanalytic Psychotherapist, Full Member of the UAPP  (Ukrainian Association of Psychoanalytic Psychotherapy)

The experience of working in conditions where the war is ongoing and the traumatic impact persists prompts me to reconsider the emphasis in understanding patients. The defense strategies that the psyche develops under prolonged stress become a priority in terms of greater awareness and comprehension. Psychoanalytic identity allows for an approach based on attentiveness and respect for defense mechanisms, moving away from the idea of weakening them to work through unconscious conflicts.

    November 2023 marked the beginning of an important professional, personal, and deeply human experience for me. It was my psychoanalytic identity and personal experience in analysis that enabled me to maintain a professional stance.

   Eight villages of the Bucha community were under the supervision of the mobile team I joined. It is essential to describe the atmosphere of the de-occupied territory. This was a time when seven months had passed since Bucha’s liberation on March 31, 2022. For 33 days, this area had been under enemy occupation. At that point, the process of rebuilding had not yet begun, and everything I saw seemed to “be suspended in silent mourning.” The most devastated parts of Irpin appeared as frozen “black holes”— impossible to approach or comprehend. Later, I heard from eyewitnesses of those events a poignant reflection: “Bucha is the soul, and Irpin is the body. The war wounded the soul and destroyed the body.”

    A similar atmosphere prevailed in the villages. Establishing contact with the local residents was challenging. Few were willing to talk, yet there was a readiness to listen—along with an overwhelming sense of expectation, as if hoping to hear something that could unblock the soul. It felt as though the psyche itself had been occupied by terror, with the effects of trauma compelling people to keep everything isolated. There was a deep desire to forget and to know nothing about what had happened.

    My first client, a 73-year-old woman, spent several weeks coming to the local administration building on the days I held sessions before she was ready to talk. She would sit or stand in the hallway as if she had come for other matters, but whenever I stepped out of my office, she would discreetly observe me. When our eyes met, she did not look away.

    In the following weeks, she began peeking into the office before quickly shutting the door, as if she had entered by mistake. I noticed that I started thinking about her from time to time. When I saw her, I had the urge to approach and invite her in, but at the same time, I sensed that I shouldn’t. My consistent presence at the location during scheduled hours seemed to be doing its work.

    The events that had been experienced were something people wanted to forget, yet forgetting proved impossible. Those who began seeking help were not yet ready to talk about their lives during the occupation, and nearly all of them suffered from prolonged anxiety, panic attacks, and sleep disturbances, which deeply drained their psyche and led to disadaptation. Many were afraid they were losing their minds or that something irreversible was happening to them. It was precisely these states that brought them to consultations, hoping for relief. During our sessions, it seemed as though there was no connection to the traumatic experience. It felt as if these states had appeared from nowhere. The isolation of traumatic experiences and dissociation served to free the inner space from psychological pain, but they also became the source of constant anxiety and fear, which occasionally spiraled out of control.

    At that time, I worked as a specialist providing initial psychological assistance, but I reflected on this experience through a psychoanalytic understanding of regression, containing, and internal objects.

    I still wonder why the majority of people I worked with for over a year did not speak about traumatic events, and only 1.5 years after the occupation did most of those who sought help begin to talk in detail about what had happened to them. Now, as I try to make sense of it, I describe this through “transformational paths,” which likely occurred more or less simultaneously.

    The first thing I thought about was the stages the psyche goes through when faced with traumatic events. First come psychophysiological reactions that increase the ability to survive, while the process of symbolisation and understanding which transforms trauma into life experience becomes available much later, when one manages to overcome shame and guilt resulting from trauma, which plunges the person into a sense of absolute helplessness, collapses thinking, and destroys connections. I arrived  at this understanding not only based on the knowledge gained through PFA (Psychological First Aid) and CI (Crisis Intervention) training, but also from my personal identification of such states in myself. One could say that this is a “transformational path” the psyche takes when processing trauma, which is universal for all people. And each stage of experiencing it requires some time. I believe that the process of processing psychological trauma is complicated and burdened by the ongoing circumstances of the war.

    A 55-year-old woman came for a consultation, looking tense and avoiding eye contact. I asked her to tell me what was troubling her. She hesitated at first, then began describing how she constantly felt anxious, had very poor sleep, and quickly shifted to talking about the period when their village was shelled with missiles and how she took refuge in the basement. After a couple of days of such shelling, the villagers decided to gather and head towards the forest, which they thought was safe. The client lived with her father, who was paralyzed, and there was no way for her to take him with her. The path they planned to take was simply through the forest. She said that she quickly decided to leave with everyone and left her paralyzed father behind in the house. Later, she learned that a rocket had hit her house. She began crying and, through tears, described how she still blames herself for this. I listened, overwhelmed by a sense of horrific contradiction, as though this were a situation in which it was impossible to choose the “right” thing to do. I then told her that she was suffering because she believed she had made the wrong decision, but at that moment, she was not capable of thinking clearly to make a decision, as her instincts were keeping her alive, and these are natural mechanisms. She cried for a little while longer, and I sat silently beside her. When she gradually calmed down, we were able to discuss and try some techniques to reduce her anxiety. We never saw each other again after that.

    The second thing I reflected on was whether I was truly ready to listen to the traumatic experiences of the residents of the Bucha community at that time. Perhaps, by then, I had not yet restored my containing capacity enough, and I might have been unconsciously signaling that I was still too scared, not ready to make space within myself for these stories. And for sure, I needed time to understand what my help should look like, considering that my previous years of experience had been in a comfortable office as a psychoanalytic psychotherapist. I was going through my own transformational process, traveling my own transformational path both as a person and as a professional.

    The third thing I reflected on was the gradual process of building a safe, stable setting and teamwork. In the beginning, my trips to the villages as part of the mobile group were more like efforts to find ways to create conditions for providing assistance to people.

    In one remote small village, a room in a family medical clinic was allocated for my work. When I arrived they had already been expecting me. The clinic’s premises were in a neglected state, and in a small, shabby office stood an empty cupboard. I looked around and began searching through other rooms to find somewhere to sit. It was cold, and there was no light. A mother and her 8-year-old son came for the session. Both looked exhausted. The mother, a middle-aged woman, immediately began to explain with fear in her voice that she didn’t understand what was happening to her son. For several months, he had hardly gone outside, and asked to draw window curtains. When he talked to his elder brothers, he always complained that they were mocking him. The boy was very tense, almost frozen, his face was expressionless, and he couldn’t speak. When we were left alone, I suggested playing “Doodle” on the windowsill. I explained the rules, and we silently took turns drawing. Something was emerging. The boy remained in a state of numbness, and only the trembling of his hands revealed any signs of movement in his body. We agreed to meet again. This session left me with a strong sense of helplessness and neglect. When the mother and the boy left, I looked around the room and thought that the environment literally reflected a state of absence, of something essential that was missing. Such emptiness and neglect both inside and outside. There was a feeling that space for processing was absent. I realized that I wouldn’t be able to work with this boy under these conditions.

    I think that if it hadn’t been for this consultation, I might not have made the decision to push for a more suitable room. The following week, we met at the community center in the neighboring village, which was cozy, although cold. We worked for two years, and I was able to help this child return to a normal life.

    “In trauma, the internal good object, as an empathetic mediator between the self and the environment, becomes silent (Cohen, 1985; Kirshner, 1993). The loss of the empathetic internal other destroys the ability to relate to the trauma. It cannot be integrated into a narrative. Only in the presence of an empathetic listener can the fragments grow into a coherent story, and the experience can be acknowledged. Distance is created through the narrative. The traumatic event and experience become testimony, thus, to some extent, they are re-externalised (Laub, 1992).” (Werner Bohleber)

    For the project, one of the key aspects was the focus on teamwork. The weekly intervision groups gradually created a stable and supportive professional space for all of us. We also came together, just like most Ukrainians. Each member of our team paid attention to caring for one another daily, which greatly helped in carrying out this work.

     With deep gratitude to the people I had to work with and for my colleagues. For those who survived, and for those who were by our side.

Essay 2 by Yana Sasina

(Psychoanalytic Psychotherapist)

In July 2023, together with colleagues from the project “Psychologists at War”, we began working in Kherson with victims of the Kakhovka Dam destruction. At that time in Kherson, we often heard from people about how the expected and joyful waving of Ukrainian flags in the city marked the beginning of endless shelling and the painful path of daily living in war.

Among other things, the peculiarity of our work in Kherson was that we had an opportunity to see most of the people with whom we conducted crisis consultations only once – on our next visit, they were most often absent: some immediately went to restore order in flooded homes as soon as official permission was received, some changed their place of temporary residence. This left us with a feeling of uncertainty and powerlessness.

In 2024, the work of “Psychologists at War” continued in the frontline areas of the Zaporizhzhia region. In summer of 2024, I also traveled independently with volunteers to Kherson as a psychologist.

Sometimes during shelling, we seemed to change roles, and the patients became those who wanted to calm us down, clearly distinguishing the incoming fire from outgoing fire, trying to protect us. Our presence in their space, and not vice versa, was perceived as a readiness to literally interact with their round-the-clock horrors, taking the risk of being destroyed, but inside hoping for a good ending.

At the same time, it was impossible to deny the presence of manic defenses both among the local population and among the volunteers and the psychologists themselves, who agreed to neglect part of the psychic reality that concerns depressive anxieties. According to Winnicott, omnipotent fantasy is not so much an internal reality in itself as a defense against its acceptance. I remember how volunteers warned me during a trip to Antonivka, which was under round-the-clock shelling and every minute of our stay it was important, that we must definitely stay for tea with the people we were going to, otherwise it would offend them. Such actions towards us can be interpreted as an attempt to directly experience what they live with every minute, to evacuate their horror to someone, while demonstrating counter-phobic behavior. It felt like people who chose not to leave their homes, despite the risks, refused to experience mourning for their lost peaceful life, stubbornly rejecting the fact that it cannot be returned. But is it possible to experience mourning in a situation when the current traumatic situation has not remained in the past, but is a permanent decoration of the present?

At the same time, it seemed that the relationship with a carefree, sometimes cruel internal object forces people to continue to live in inhuman conditions without access to medical care and basic amenities. The symbol of such a relationship for me was the Kherson hostel in an area open to attacks from the left bank. This hostel belongs to one of the industrial enterprises that has long ceased to operate. Almost all the windows are boarded up, there is often no light, no Internet, but people continue to live in several rooms, although they do not have permanent jobs, and this housing does not belong to them.

Sometimes our own powerlessness pushed us to direct action, and from psychotherapists we were turning into social workers – responding to direct requests for help – buying food, organizing evacuation, accompanying in search of a new home. Was this also a manic defence from powerlessness? Partially yes. It seemed that in a situation of constant danger, which intensified paranoid anxieties, it was impossible to restore faith in good objects, just as it was sometimes impossible to face one’s own vulnerability, disappointment, and anger.

In routine psychoanalytic work with patients, we study the history of their personal catastrophe, or, as Bion puts it, “we extract facts concerning the ‘primal disaster.’” When the primal disaster is confronted with a real catastrophe, faith in the fundamental goodness of objects and the world itself is shaken. According to Caroline Garland, “The loss of faith in the protective function of good objects … inevitably leads to the revival of fears about the cruelty and power of bad objects … The internal object, which, according to the individual’s conviction, should have come to the rescue, turned out to be indifferent, and worse, evil.”

Among the Kherson residents with whom I worked, almost no one spoke about the shelling or experiences directly related to the war. The stories were more about the loss of the object and the powerlessness due to the inability to save it. Thus, one of the residents of the aforementioned hostel shared a memory of how, long before the full-scale invasion, her husband, who suffered from alcohol addiction, set himself on fire in front of her eyes. Attempts to save him were unsuccessful – he was taken to hospital, but soon died. As I listened to her story, told in a rather self-composed way, I tried to imagine the scale of the ruins, as well as how the history of the past comes alive for my interlocutor with each day of the war. It seemed that not a single word of mine would matter. But I thought that the very feeling that you exist in the inner world of understanding, containing Other with all their pain, fear and spiritual shame, the Other who confirms the enormity of mental and physical damage finds hope of healing.

In Kherson, which was damaged by shelling in the summer, I was amazed at the well-groomed trees and flowers in the neighborhoods. It seemed that locals were externalising their own need for care by loving plants and street animals.

I remember a woman who came to a school reception who was offended by her own sister, with whom she could not negotiate who should take care of their mother. At first, she complained about her sister for not taking good care of her paralysed mother, but then it turned out that the sister simply did not want to return the patient’s mother, but wanted to take care of her herself. I noticed that perhaps this was her own desire – to be under the protection and care of someone with whom she could be helpless in complete safety. She thought about it and said that she seemed to understand better why her sister did not want to return her mother to her.

It was the psychoanalytic identity, not the identity of the crisis psychologist, that was the backbone that allowed many of us who practice in this modality to keep our backs straight, our heads above the surface of the waves that flooded with fears and grief. By meeting in regular supervisory work groups, we had the opportunity to experience for ourselves the importance of having an empathetic and containing Other. In emotionally difficult traumatic moments, the subject is left without the benevolent reflective presence and hope that help maintain a good internal object. As Alessandra Lema and Susan Levy have written, traumatised patients attack attachment, and with it the possibility of dialogue and exchange of experiences with the Other. Indeed, sometimes it seemed that we, psychotherapists, were more interested in the conversation than the patients. However, if it was possible to establish even an unstable contact, one could feel how important it was to have someone present next to these people who would give space and voice to their pain.

Essay 3 by Sergii Ugrium

(Psychoanalytic Psychotherapist)

The metaphor of the “severed roots people” is used to describe people who, due to the brutal war circumstances, were forced to leave their homes and radically change their lives, becoming “uprooted” from the context of their typical libidinal investment. Regardless of the external personal circumstances, the essay discusses ways in which their internal space is marked by multiple losses as well as significant difficulties in investing in and adapting to a new life. I also focus on the challenges of engaging in the process of grieving at a time when losses are uncertain and mentalising or object formulation is possible. In addition, I note opportunities and tools that can be made available for this process in the format, even during a one-time psychological intervention via a crisis hotline. 

3.1 Transformation and Challenges of Psychological Assistance in Wartime

The experience and reflections I share were born from the meta-event we Ukrainians call the Great War, which has unleashed a torrent of changes in the physical and emotional life of every Ukrainian. Certainly, wars are complex situations with specific effects on the inner world of every individual. In Ukraine, the war situation encouraged mental health professionals to propose initiatives to quickly and effectively address the “mental fire” that has engulfed Ukrainians. Concepts such as deep, complex, non-linear, multilayered, and long-term psychological work — the epithets familiar to our profession, especially in psychoanalytic practice — have given way to urgent psychological aid. This new reality prompted many Ukrainian psychoanalysts to make unprecedented changes in the psychotherapy process, both with their new patients as well as patients who have been engaged within what is viewed as a «standard» therapeutic setting (Dorozhkin, 2023; Lagutin, 2023; Nalyvaiko, 2023; Velykodna, 2023). Notably, no psychoanalyst in these times can ignore the relevance of acute ongoing war trauma or reduce patient issues exclusively to familiar internal conflicts and the traumatic events of childhood. In each of our patients, we now can see the images of war and its impact on the individuals’ psychic foundations.

One initiative to address mental health needs during this wartime is the psychological hotline for emergency or crisis assistance, established by the National Psychological Association of Ukraine (Palii et al., 2023). The hotline combines the efforts of professionals from various psychological fields and orientations, such as cognitive-behavioral, gestalt, humanistic, and psychodynamic, making it possible to share experiences, observations, and findings together with colleagues across numerous theoretical traditions. The current format of the hotline is based on a one-time remote session of up to one hour. Certainly, such a format is unusual and creates challenges for psychoanalytically-based clinicians like myself, who are used to having a protected private space as well as sufficient time with the patients to work through their traumatic material. At times, I felt like a surgeon who was used to a meticulous, dedicated workspace for surgeries, being suddenly placed in an intensive care unit and, even more challenging, in a make-shift mobile medical unit. I wondered whether I could be useful in a one-time counseling format and what I could do to facilitate the creation of a supportive, safe therapeutic container, while I and they faced so much destruction and threats to life. Therefore, my reflections on this work are based on an in-depth understanding within psychoanalysis of the processes, often evident in a psychic content, that speaks to humans on the verge of death or survival.  I could also draw on my ability to hear beneath or what is not conveyed directly in words via the rational part of the discourse. I could focus on my ability to create a distinct containing space that could be relied on by patients to reduce their excessive pain and anxiety. Finally, I could engage in this work through my willingness to accept the vulnerability of our human nature and the finite nature of our being, which emphasises the profound value of human life.

Certainly, each individual story is unique, holding distinct sets of circumstances and an unfolding life path. However, being in the midst of a war is a possibility about which most human beings rarely think about or plan for, and for which individuals are not mentally prepared. War experience offers no standard theoretical developmental categories, identifiable algorithms, or guidelines; most humans have no rules for coping or engaging with wars. Today every Ukrainian confronts this apocalyptic situation of uncertainty and threat to life. Many Ukrainians, even if (temporarily) physically safe from Russian aggression, have relatives who had to remain in the war zones. A tremendous number of Ukrainians lost their homes, lands, or property. Many Ukrainians endured the horrific experience of escaping to safety under active military fire. Many had to abandon everything, leaving their homes and lives in order to find somewhere safe to stay alive. Among the most striking observations I made, which I will further discuss below, is how much these details and difficulties, which vary greatly, appear to be secondary to something deep and profound, which is present in almost every Ukrainian story and which often does not appear to correlate at all with how successfully a person seemed to overcome the war circumstances. I suggest that the scale of this apocalyptic event cannot be comprehended through rational arguments or common sense, which is typically used to assess human situations.

3.2 The Crisis of Life Investments in the Face of War Migration

I don’t know how to describe my condition. I don’t know what exactly worries me. I guess I am confused by my existence here. I feel like a tree that fell into a river and was carried away. It’s almost impossible to understand where my legs are and where my head is. And then it’s like this tree was washed up on some bank, at least temporarily. I’m not even a tumbleweed, which has this nomadic nature, but just a tree with severed roots, or better yet, a half-living piece of wood that used to be a tree.

This self-reflection was shared during one of my consultations, poetically describing one of the central issues of the experiences faced by people who were forced to flee their homes in order to escape from the frontlines, internally in Ukraine or abroad. My attention in hearing this statement was drawn not only to the content of the experience but also to the form itself: I felt as if something large, heavy, and without a clear structure filled the inner and intersubjective space. Words we can access seem simply powerless in holding and describing what is being experienced.

Individuals who manage to verbalise their states beyond simple statements such as “I feel bad” or “Life has lost its sense” and build some connections to their mental states typically describe their primary concerns as the inability to fully adapt to new life conditions, to accept other «rules of the game», to «live in the present», to formulate plans and make connections, or to allow themselves to experience positive emotions. For them,  life was put on hold without instructions or explanations. A closer study of such cases revealed to me that total maladjustment, rejection, and even attacks on the new situation are often related to manifestations and consequences of the crisis of life investments because the environment, the reality of the present, plans for the future, and the person’s life itself ceased to be the primary objects of normal libidinal investments. 

I view the concept of life investments as libidinal investments arising from psychic processes that serve life goals, especially the formation of object connections and social integration. This psychic life investment stands in opposition to destructive changes that play on the side of death drives, the idea of which was developed by Freud just after the First World War in 1920. In general, these concepts focus on the channeling of libidinal energy, in particular the interests, attention, and aspirations, toward what fills a person’s life — their location, environment, activity, plans, connections with other people, and so on. These are also investments of the Self as an agent of solving problems and achieving desired goals. Thus, the focus is on whether a person’s life is filled with actual vitality or whether it is just a mechanical existence using a kind of perverse mechanism that prevents the emergence and development of something more alive and resilient. If this vitality somehow “evaporates” from life, it is important to understand what factors contribute to its diminishment or absence.

In the context of interest in life, the very act of making self-assertion or requesting assistance is a very important step. Thus, those of us working at the hotline usually emphasise this important form of life investment in a crisis conversation with a patient. The person has invested also in speaking with the other (i.e., one of us as crisis responders) who can help them locate new knowledge/information and a place within themselves for this emerging understanding. Certainly, not every person who calls the hotline expects help. In addition to the constructive options that prompt many to call in for assistance, their subconscious motivations may be different and, at times, even destructive. They can call to gain the elementary release of their problematic impulses or they call in order to re-affirm the stalemate in their situation–their hopelessness, their sense of futility in making any effort. Thus, one of the most traumatic effects of war is the breaking of links, including untying the drives of life and death, leading to the inability of Eros to restrain Thanatos, which often leads to the uncontrolled dominance of the death drive and the blocking of purposeful activities. However, in cases where there is some hope present, which is essential to life investment, supporting it is one of our main tasks in brief hotline crisis interventions.

Typical experience shared by Ukrainians displaced by war is something along the lines of “Most of all, I want to go back, but I can’t right now because I have small children/a mother who needs treatment/it’s not safe at all.” It evokes solidarity and full understanding both on the part of the voiced (internal) desire and the (external) arguments provided. Noting the shared basic desires of Ukrainians, we can still engage them with questions such as “Where does the person actually want to return to?; Why does it not work out?; And how does all this affect their current mental state and adaptation?” It is in these further questions that the life investments can be examined, including what might have destroyed them and where they emerge to the surface of awareness. Notably, for many individuals, these investments are anchored to something that is no longer available. Therefore, we must recognise and work with the logic of libidinal deadlock in their experience of loss.

3.3 Difficulties and Successes of Integration and Symbolisation Processes in Overcoming Loss

Displaced people, especially those who have found themselves abroad within a radically different environment, way and pace of life, may show signs of defensive disidentification. In a sense, they cannot integrate their self-states that are based on their past and their present. I have especially observed such defensive moves as, “canceling” or devaluing their skills, experience, and knowledge. Time appears to them as warped: the fixed boundaries of memory are blurred and faded, the past only shows up in a striking and strange way, and the future has no definite image or outline. Their Self seems to be less tied to certain internal images, ideas, and feeling states; they seem to start “drifting” (Ivanova, 2023, p. 57). At the same time, their Self finds itself under extreme pressure, which can be profoundly exhausting. On the one hand, their deep narcissistic wounds are evident: being a war victim, a refugee, a person who has lost almost everything, including stable narcissistic support systems. The castrating effect of “starting from scratch” can be shocking, and there is a kind of mental splitting of life into “before” and “after” with difficulty in using the experience that is already gained. Thus, the task of the counselor often lies in bringing the person out of this state of shock and helping them identify how their existing knowledge and skills can be applied in the current situation. On the other hand, the Self appears as if captured by a haunting sense of guilt that blocks any attempts to invest in a new life and tap into an important mental resource in the form of pleasure. Personal goals fall under strict prohibitions, and only the over — and transpersonal acts begin to matter (Dorozhkin, 2023, p. 34). These splits are also expressed in the irrational fears of adaptation based on the fear “What if I like it?” This fear can nearly automatically level out previous cathexes and a person’s will to choose between “here” and “there,” “now” and “then.”  However, investing one’s life in the present also implies investing it in the past, because human beings base their experiences and knowledge on the sources from their past. In addition, investing in the present is a requirement for the libidinal investment also in the future because such inner work creates a kind of base for future recovery.

Sometimes I hear crisis clients  state, “I was so happy in my ordinary life.” Thus, even routine can take the place of a good object that has been lost. This loss reminds me of the words of an apt proverb translated from Ukrainian: “When we have it, we don’t appreciate it; when we lose it, we cry.”Or the English equivalent: “You never miss the water till the well runs dry”. In these times, what was perceived as a broad contextual environment, merely as a background, can become a figure, be transformed into a good object, and acquire new special significance. In my view, this process is psychically advantageous because reinvesting in routine processes may help people regain a sense of control or coherence as well as activate their goal-setting.

3.4 Clinical Case Examples and Observations

The following four brief examples taken from consultations on the crisis hotline demonstrate different approaches to losses, often identified by the person at an unconscious level of communication. I hope to illustrate both psychic stagnation and more successful adaptation scenarios.

The first case example, which was particularly characteristic of the beginning of mass migration by Ukiranians fleeing the horrors of war, features a woman who crossed the borders. In the crisis session, she describes taking her belongings out of her suitcase at the beginning of each day and packing them back before going to bed. Thus,  she shows (rather than tells) about her expectation of not staying in the new location for a long time. Her unpacking and packing is a metaphor for the preservation of her past experience and knowledge while also pointing to the avoidance of the integration into her current situation. This pattern also resonates with the use of psychic retreats in the formulation of Steiner (2022), mentioned earlier. This person with a suitcase denies the fact of her existence in a changed reality, where it is necessary to unpack her belongings (her libidinal investments) and to find new places for them.

The second example demonstrates a transformational process. A Ukrainian refugee woman described how every Sunday, she and her children actively sought out experiences in nature in their new country. She noted that this tradition carried over from her life in Ukraine in their hometown. Thus, a person can actualise their habitual pattern of behavior in different conditions. Moreover, this client described her experiences through the lense of enriching (adding to) herself and her children with new impressions of another place.

The third example illustrates the formation of symbols that may be important in the work of mourning. A woman I met shared that when she was little, her grandmother often wore a beautiful blue embroidered (Ukrainian) dress during the holidays, which was a cherished memory because it was associated with moments of joy and happiness. While abroad, the woman suddenly decided that she should have a similar blue dress. She then described her profound surprise when she saw almost the exact same dress in a foreign store and bought it. Certainly, the point of this case is not that she bought a similar dress in the literal sense but that, first of all, she invested, within her mental space, in the process of mourning, which may have aided her in holding on to a good object and a positive past experience.

Finally, I wish to share an example that I particularly liked and which I experienced as an example of a psychological discovery. The case involved writing letters to the self in the past. In these letters, the person described their present life, experiences, and difficulties, referring to images in the past as the Other. In one such example, a woman shared a letter in which she wrote, “Remember, your husband taught you to ride a bicycle, so today I finally understood what all those scratched knees were for.”

In conclusion, undoubtedly, each human being, especially when facing war, finds their individual unique way to integrate their experience, to symbolize their losses, and to understand that despite great changes and significant challenges, they can retain the core of their personality. Even in the horror of war conditions, human beings can hold on to the core of their being, which indeed strives to live no matter what.

Esay 4 by Olena Gladkova, Veronika Lukyanova, Kostyntin Siguta, Ruslana Rudenko

We are going to discuss one of the most difficult aspects of psychoanalytic work – interaction with the military during active hostilities. This is a subject that raises many questions and contradictory opinions, because war changes not only a person, but the very foundations of our approach to therapy.

Psychoanalysts, although usually far from the front line, find themselves at the forefront of internal conflicts among military personnel. Sometimes these conflicts are so urgent, unbearable and dangerous that the psychoanalyst comes under a devastating ‘bombardment’ of the soldier’s unrestrained emotions.

4.1 Peculiarities of the Countertransference in Working with the Military

In the context of working with the military, where complex, often deeply traumatic experiences dominate, the therapist may feel anxious, ambivalent and powerless to engage deeply with emotionally charged material. 

Countertransference in such work is not just a concept, it is a reality that affects the effectiveness of the encounter. If we give in to the emotions, begin to “rescue” the soldier, or try to artificially inspire respect and importance, we lose our neutrality and become either an accomplice or a judge, or we are excluded from the possibility of creating a therapeutic alliance.

The analyst may also encounter his or her own defense mechanisms activated by contact with the analysand’s trauma. For example, a rationalisation or even alienation mechanism may be unconsciously used to minimize the impact of the complex emotions.

According to Winnicott’s concept, the therapist must be “good enough” to withstand the patient’s projections and maintain his or her own integration despite complex countertransference emotions.

The phenomenon of “shared resonance” described by Kohut is also important in this context. The analyst can feel merged with the client’s emotional experiences, and this requires a high degree of self-awareness and self-reflection. The ability to separate oneself from the client, to remain empathically engaged but not absorbed in his or her trauma, is the key. It is important for the therapist to be aware of their own reactions, which may include fear, defensive distance or even projections about the role of the military.

Personally, during my ten years working with the Ukrainian military, I often found it helpful to recognize their experience and strength: “What a strong person you must be to recognise the need for help, (i.e. to recognise your weakness)”.

War teaches us to be armed not only with classical psychoanalytic training, but also with knowledge of clinical psychology and psychiatry of acute stress states. Being reliable, knowledgeable and able to normalise experiences is one of the key tasks in the phase of getting to know a soldier. We become containers for fears and experiences that can be transformed from frightening and incomprehensible monsters into understandable and normal manifestations of stress experienced by everyone in the course of a session.

It is important to remember that the military do not turn to analysis to deal with the deeper problems of childhood. They come with symptoms of stress disorders that manifest themselves here and now. Therefore, knowledge of what exactly is happening to a military patient is a priority for any professional working with this category of clients. This knowledge gives peace of mind, confidence and awareness and forms the basis of an analytic relationship. 

4.2 Peculiarities of bodily transference in working with the military.

Working with the military and civilians who have been in Russian captivity has proven to be an extraordinary challenge for Ukrainian analysts. When working with a patient who is simply recounting the facts of his past captivity, the therapist experiences physical pain in different parts of the body with different patients. This pain may be familiar to the therapist from their own experience, or it may appear as something previously unknown and disappear as soon as the patient leaves the office.

4.2.1 Clinical vignette.

While working with a 17-year-old boy who had been captured by the Russian occupiers for his clandestine intelligence activities in an occupied city in southern Ukraine, I constantly experienced spasms of acute stomach pain during our work in the office. And although this minor boy was not subjected to the same physical torture as adult men, there was a lot of psychological intimidation.  It was only at one of our last meetings, after three months of work, that he told me that he had not been fed by Russians for several days.

In our psychotherapeutic work with the military, we often encounter the phenomena of somatic transference and countertransference, such as headaches, tension in the body, difficulty breathing, psychomotor agitation, difficulty sitting still, and so on. Sometimes it is the somatic reactions in the countertransference that can be indicators of a client’s condition, even if they do not talk about it in the session or are unable to consciously recount their traumatic experience. In addition, very often we are dealing with a person in a psychotic state, where the connection between emotions and their manifestation is disrupted, or even the presence of emotions is denied by the client.

Thus, the body should be seen as the starting point of mental processes and as the primary source of experiences for which one must take responsibility and reflect. 

In his later work, Bion emphasises the body as a container of germinal elements that give rise to a new thought that has never been thought before. He also underlines the role of the analyst as the “midwife” of the thought struggling to be born.

 In this way, he highlights the importance for the human psyche and the ability of the psychoanalyst to endure the unknown in order to respond to the need to think about something when it arises. 

The idea that we are unaffected by the patient’s destructiveness does not indicate neutrality, but rather falsehood or deafness. The question is how the analyst allows himself to experience the experience, digests it, formulates it and communicates it as an interpretation, which is crucial to the therapeutic process. 

This requires the ability to “withstand” the countertransference that arises. We must be able to “allow ourselves to experience the patient’s projections in all their power and at the same time be able to avoid acting out”. 

Words give us a way to organize our experience, but they also distance us from the primary sensory experience… In therapy, there is a constant tension between the need to provide enough containment…to be able to look at what is troubling us, and the need not to lose touch with the reality of the experience as it is lived. Many memories are not encoded in words, but in physical memory. 

Accordingly, it is important for the therapist to be able to access their own bodily memories, bodily affective states and feelings in order to distinguish their own material from that of the patient. It is only by noticing and paying attention to one’s own reactions to the patient’s unspoken reactions that the therapist can access the information necessary for the patient to benefit, to hold on to their unexpected bodily sensations, and thus to model self-regulation for the patient. 

Selective disclosure of somatic countertransference experiences is valuable when it is appropriate, or when it is used to verbalise empathic comments or interpretive relationships.

4.2.2 Clinical vignette.

A military paramedic, who was released from Russian captivity, a man in his 40s. He returned to the front line immediately after his release. At our sessions he told me only of the psychological torture and traps the Russians set for Ukrainian prisoners to get important information about their relatives and to extort money from them in the vain hope of releasing their loved ones. While working with him, my legs and arms were terribly cramped, I felt completely helpless and unable to move. My patient, whose father was dying of cancer at home during the captivity, felt equally helpless and in terrible pain and fear that he would not have time to return and say goodbye to his father.

He was able to say goodbye to his father and bury him because, fortunately, he was exchanged very quickly. However, he was unable to overcome his grief and turned it into rage against the enemy, which later consumed him completely and resulted in aggression against any of his comrades. He turned to medication, which led to apathy, depression and suicidal thoughts six months later. It was only his love for his daughter that kept him from engaging in extremely risky behavior and eventually prompted him to come to me for the psychological help. We worked for three months during his treatment for depression (1 month) and two months when he returned to the front. We said goodbye when he was able to accept his depression and mourn his father’s death exactly one year after his father’s death.

It is also useful to understand the analyst’s body as an ever-present component of the setting that maintains a sense of the setting’s integrity and thus its containment capacity, and here again, any change can arouse fantasies and anxieties in both the patient and analyst. Physical appearance of the analyst and how he/she feels in his/her body and in the physical space of the office – how he/she sits in the chair, breathes, moves around the room, talks, dresses, etc. – establishes key sensory parameters of the setting that also contribute to the containing required of the therapist.

Conclusion

Thus, in the model of the H4H project dynamics in the created analytic framework it was possible to observe characteristic processes triggered by war traumas on the personal and social level: disintegrating invasion of external reality and efforts to integrate, preservation and search for a good object and request for helping involvement from the outside, and the need for the presence of a third object (as a non-involved in paranoid-schizoid world, empathic and receptive witness, unlocking by its presence the tightness  and intensity of contact with the traumatic reality, search for and creation of a new and more effective way to help the traumatised person. After almost three years of project work we can say that short-term interventions are a real possibility to help in crisis situations, when the need is great, but resources are limited. We continue to seek answers to the questions: what are the possibilities and limitations of psychoanalysis in short-term crisis counselling and intervention groups of this kind? What are the possibilities of psychoanalysis when its basic tools – the setting and the analyst’s psychic apparatus – are attacked from the outside and the inside?

Observing the development of the project, – dynamics of the groups, emergence of the Big Working Group, the initiative and creative activity of the Discussions Groups, –  we definitely can say that  the project not only succeeded in its containing function, but helps to restore the symbolic functioning of the psyche and the internal space of the participants in which the traumatic event can be reflected on and experienced as a “memory with emotion and meaning”, to “historicise” the trauma, transforming it to the register of subjective experience, and to mobilise the internal reparative resource. Recently Caroline Garland at Melanie Klein Trust’s webinar on trauma said: “A traumatised person will never become the same as he was before the trauma. But the trauma can become only a part of his life story, and not something that defines one.”  We think that these words express the main goal of the H4H project and the main  purpose for helping counselors in working with consequences of war trauma. 

The current IPA administration created  the PACE (Psychoanalytic Assistance in Crises and Emergences) committee in 2021. At the 38 EPF Conference in Florence in 2024 Mónica Cardenal, the head of PACE Committe,  said that now it might be one of the worst moments of Humanity. The IPA has gathered colleagues from different continents: Asia, Africa, North America, South America, Europe, Oceania. Committee members and contact colleagues all work together, developing projects directed to the most vulnerable communities in the world, offering psychoanalytic interventions, helping as many affected persons as possible. PACE committee tries to reach and deploy interventions that have helped those who need the most and believe in the need to take psychoanalysis beyond the couch and have an active, containing and repairing presence in emergency situations, which are ever more frequent around the world, reaching in this way the people in need, those “who have lost everything”.  At the EPF Conference in Florence we met with colleagues from SOS Brazil projects who are working in Latin America now based on the familiar principle and structure. The necessity in such kind of projects are extreme and reparative potential is proven.

References:

1. Bion, W. R. (1962) Learning from Experience, London: Heinemann.
2. Britton, R. (2015) Trauma in Kleinian psychoanalysis. In Borossa, J., Bronsein, C., Pajaczkowska, C. (eds) The New Klein-Lacan Dialogues. London, Routledge, p.139-148.
3. Garland, C. (1998) Thinking About Trauma. In: Garland, C. (ed) (2002) Understanding Trauma. A Psychoanalytical Approach. Second enlarged edition. London, Karnack, pp 9-31.
4. Taylor, D. (1998) The psychodynamic assessment of post-traumatic states. In. Garland, C. (ed) (2002) Understanding Trauma. A Psychoanalytical Approach. Second enlarged edition. London, Karnack, pp 47-62

5. Cardenal, M (2021) Identifications and emotional experience. The introjective identification, its consideration in the analytic work. 38^th EPF Conference, Florence, march 2024
6. De Egea, S., Readi, R. On Projective Identification in Brief Interventions, 38^th EPF Conference, Florence, march 2024
7. Shay,J (1994) Achilles in Vietnam: Combat trauma and the undoing of character. Scribner.
8. Britton, R. (2023) “Before and after the depressive position: Ps(n)→D(n)→Ps(n+1)”, in: Britton, R. Belief and Imagination. Exploration in Psychoanalysis. Hove and New York: Brunner-Routledge, pp. 69­-81.
9. Малишко, І. (2025) «Єдиний шлях «із» – це «крізь». Про вплив війни на життя та психоаналітичну практику». Український Психоаналітичний Журнал, 3 (1), 36-50, htpps://doi.org/10.32782/upj/2025-3-1-5
10. Olena Gladkova, Veronika Lukyanova, Kostyntin Siguta, Ruslana Rudenko. Report on the Big Working Group of the ”Help for Helpers” Project , 12.03.2025, “Prisoners of war. What can be saved: body, mind, soul? Psychoanalytic Reflections on the Physical and Emotional Experiences of Working with the Military in Times of Active Warfare”

Iryna Malyshko, Dnipro, Ukraine

Ukrainian Psychoanalytic Society

malyshko.irina@gmail.com