When Words Are Not Enough ... Psychodynamic Psychotherapy in Chronic Conflict Settings Intervention 2010,Volume 8, Number 2, Page 146 - 147

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When words are not enough ... psychodynamic psychotherapy in chronic conflict settings Intervention 2010,Volume 8, Number 2, Page 146 - 147

When words are not enough ... psychodynamic psychotherapy in chronic conflict settings

Susan Prosser & Ahmad Bawaneh

The ¢eld of mental health and psychosocial Within an Arab context, the western concept support is now globally recognised as a valid of ‘I’ as an autonomous separate individual element of humanitarian aid. Me¤decins is more likely to be ‘we’. Networks and sys- Sans Frontie' res has been a leader in this tems of interpersonal family, tribal and civil work for many years. On re£ecting on the relations are more collectively understood article by Gaboulaud et al. (2010), we pose in the Arab culture. Working with individ- the following questions (detailed below): uals may not be re£ective of Arab culture: How would psychodynamic psychotherapy even if it does not stigmatise the individual, have to be adapted to the Palestinian con- it does focus attention on a ‘problem’ being text? What is the role of interpreters? How with the individual, rather than a re£ection e¡ective and sustainable was the work? of the overall social and political contextual environment. Moreover, psychodynamic How was psychodynamic psychotherapy is based on the principles that psychotherapy adapted to the di⁄culties experienced in adult life originate Palestinian context? in childhood and that methods of adaptation It was a brave step by the authors to put to deal with childhood di⁄culties may no psychodynamic psychotherapy under investi- longer be e¡ective for an adult. So it would gation. One question that arises is why this be highly relevant to learn how this core form of therapy was identi¢ed as the most principle has been adapted, especially in appropriate intervention for this particular working with children as young as four years population? The therapeutic techniques of age. For readers, it would also be inter- of psychodynamic psychotherapy are based esting to have a description of the team on interpretation, the conscious interplay training, of the adaptation process of the with the unconscious, transference, coun- instruments, and of the discharge require- ter-transference and the emphasis of de- ments. In general: what trans-cultural adap- velopmental experiences shaping adult tations were made, and on what basis and personality. A tantalising reference is made how? to the object relations school of Winnicott, who emphasised the relationship between the mother and child, but how do these What was the role of the dynamics work with the primary present- therapist and interpreter? ing issues (bed wetting, fear, etc) in the Psychodynamic psychotherapy relies on the context of chronic con£ict in the occupied interpersonal client/therapist relationship Palestinian territory? more than other forms of depth psychology.

However, neither the role of the therapist, there any involvement and/or hand-over to nor the role of the interpreter are mentioned other social support services? This kind of in this work. This is perhaps even more intervention may be both more sustainable, relevant given the importance of literal and probably more accessible, if it was inte- interpretation and ‘free association’. For a grated into the primary health services. In therapy that is based on the conviction that small communities, to have home visits can life issues and dynamics will re-emerge lead to stigma, misinformation and gossip within the context of the client/therapist of ‘problem families’. Therefore, it is important relationship as transference and counter-trans- for the authors not to point to the Intifada ference, a core component of this article as a reason for the populations’ su¡erings should include a discussion of the dynamics and stress. The approach and framework of using an interpreter. In particular, when appears not to encourage client participa- one also has the ownership of the history tion or empowerment. The client is pro¢led and the story of the occupied Palestinian ter- as completely passive. And if there is one ritory within those dynamics. The working thing Arabs are not, it is completely dyad (client/therapist) becomes a triad of passive... three.The interpreter is the point of transference and counter-transference and not the therapist. Yet, the interpreter remains a Reference non-person in the article. Did the inter- Gaboulaud,V.,Reynaud,C.,Moro,M.R.,Roptin, preter receive any speci¢c training? How is J., Lachal, C., Brown, V. & Baubet, T. (2010) the supervision structured to include the Psychological support for Palestinian children interpreter? Was the therapeutic model and adults: an analysis of data from people adapted in consideration of this triad? referred to the Me¤decins Sans Frontie' res programme for behavioural and emotional Was the therapy useful for all? disorders in the occupied Palestinian territory. The limitations of the therapy were well Intervention 8: this issue. elucidated though the article would have bene¢ted from same re£ective comments Susan Prosser is a Senior Accredited Psy- on other variables. All individuals were chotherapist and member of the British Associ- eligible for therapy, though there is no men- ation for Counselling and Psychotherapy. She tion of what percentage were felt to be inap- is currently workingas Child Protection Psycho- propriate for the rigours of psychodynamic social O⁄cer at UNICEF Middle East & therapy and what other service might have North Africa Regional O⁄ce (MENARO) in been made available.Wemiss a comparative Amman, Jordan. analysis of (non/other) treatment results. email:[email protected] We would be interested to know how much Ahmad Bawaneh has a PhD in Counseling the authors attribute improvements to psy- Psychology.He worksasa Programme Manager chotropic drugs, therapeutic techniques, or for Psychosocial Department with International the therapeutic relationships? What were Medical Corps (IMC) in Amman, Jordan the main reasons for ending therapy? Were