Clinical Social Work Journal
ISSN 0091-1674
Clin Soc Work J
DOI 10.1007/s10615-015-0525-6
Transference and Countertransference Issues During Times of Violent Political Conflict: The Arab Therapist–Jewish Patient Dyad
Roney Srour
123
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ORIGINAL PAPER
Transference and Countertransference Issues During Times
of Violent Political Conflict: The Arab Therapist–Jewish
Patient Dyad
Roney Srour1
Springer Science+Business Media New York 2015
Abstract The complexity of long-term, dynamically
oriented psychotherapy with a patient who belongs to an
‘‘enemy’’ national group, requires more than cultural sensitivity,
especially during ongoing violent political conflict.
This paper deals with some of the transference–countertransference
dynamics that face therapists from a minority
group involved in a political conflict with the patient’s
majority group. Clinical examples from the Palestinian
therapist–Jewish patient therapeutic dyad are presented in
order to clarify these issues as they relate to setting, contract,
interpretation, and termination of therapy. The main
argument is that the therapist in such cases has to process
not only his sense of threat, anger, and guilt in order to
develop a good containment function during therapy, but
also has to work on integrating different and denied parts of
his national identity in order to be able to hear other, more
internal dynamics in the patient’s mind, which are conveyed
via the political conflict reality and transference
issues.
Keywords Cross cultural countertransference
Palestinian Israeli conflict Cultural sensitivity Psychoanalytic
psychotherapy
In a world of political conflict, mental-health professionals
are often called upon to help patients from the opposite
camp. A therapeutic dyad in which therapist and patient
come from enemy groups involved in bloody, violent,
political conflict, is very complicated, and skills beyond
cultural sensitivity are required to handle this intra- and
interpersonal context professionally (Nuttman-Shwartz
2008). The Arab–Jewish therapeutic dyad is a unique example
of such circumstances.
Historical and Professional Background
Arab Palestinians who live in Israel are citizens of the State
of Israel, have lived in this territory for decades preceding
Israeli statehood in 1948. As a result of the Arab–Israeli
war of 1948, about half the Palestinian population who then
lived within the Green Line (pre-1967 boundaries) became
refugees in neighboring Arab countries and live there to
this day, while the others remained in Israel. Despite being
citizens, Arab Palestinians are an underprivileged minority
within Israel. This population, whose mother tongue is
Arabic, numbers about one million. In other words, about
18 % of the Israeli population is Palestinian, consisting of a
Muslim majority, and Christian and Druze minorities. The
relationship between the Palestinian minority in Israel and
the State of Israel is not usually violent, but there is much
bloody political violence between the state and the Palestinians
who live in the Occupied Territories (West Bank
and Gaza). This violence may include rockets attacks and
suicide bombing on the Palestinian side; and arrests, invasions,
breaking into homes, checkpoints, and bombings
on the Israeli side. This violence affects Palestinians inside
Israel on the emotional and social level.
In this paper, I use the term ‘‘Arab therapist in Israel’’ to
designate Arab Palestinian clinical psychologists and psychotherapists
living and practicing in Israel. Most of the
Arab therapists in Israel were born in Israel, are Israeli
citizens, and most received their academic degrees from an
Israeli academic institution where the languages of
& Roney Srour
roneyfay@hotmail.com
1 Bishoph Hajar St. 5/23, 35379 Haifa, Israel
123
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DOI 10.1007/s10615-015-0525-6
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teaching are Hebrew and English. Among Arab Palestinian
therapists in Israel, some graduated from overseas universities,
but whether one studied in Israel or overseas, certification
requirements in Israel are such that training must
be done in Israel within the public mental-health system.
For Arab Palestinian society, which is more traditional
and collectivist, mental-health professions in general and
psychotherapy in particular were unfamiliar until the
1990s, so that most Arab therapists in Israel are still
younger and have less seniority than their Jewish colleagues.
Consequently, the young Arab therapist is currently
taught and supervised by Jewish professionals, and
often has Jewish patients. While the average Arab therapist
in Israel has an Arab Palestinian ethnic identity, this
therapist is surrounded by Jewish professional partners who
have little understanding or empathy toward this cultural,
political, or historical background, especially in times of
violent events (Baum 2006; Ramon 2004).
Very few Jews turn to Arab therapists, while many
Arabs turn to Jews. I believe that this is because some Arab
patients may feel that their culture is underprivileged, defeated
and less valuable, and thus they identify with the
aggressor and look for a Jewish therapist as part of their
idealization mechanism. This view confirms with analyses
by other Israeli authors (Bizi-Nathaniel et al. 1991; Gorkin
1987; Yovel 2001). However, this imbalance may also be
due to the fact that Arab therapists have less seniority.
Regardless, Jewish patients prefer the familiar, known
other who is not labeled as an enemy and inferior. In the
public service, the situation is different, and no one has a
choice of therapist—by nationality or otherwise. Hence, it
is usually in the public setting that we find the unfamiliar
therapeutic dyad of Arab therapist and Jewish patient.
Another reason may be related to the inaccessibility of
public mental-health services in Arab towns, meaning that
Arabs have to travel to a nearby Jewish city in order to
obtain public mental-health services, usually with a Jewish
clinician.
Literature Review
Cultural sensitivity calls for knowing about the other’s
group, being aware of stereotypes, and being nonjudgmental
toward different values and world views (APA
Guidelines 2003; Dyche and Zayas 2001; Garrett and
Pichette 2000; Sue and Sue 1990). Therapists must also be
aware of their own different and dissociated ethnic identities
(Bodnar 2004). Considering racism an extreme form
of cultural insensitivity, the literature regarding white
therapists and black patients shows how strong feelings of
anger, guilt, fear, mistrust, and feeling of superiority could
unconsciously interfere in the therapist’s interventions and,
at times, lead to misuse of the power differential that exists
in the therapeutic space, as it does in the world outside
(Chandler 2007; Comas-Diaz and Jacobsen 1991; Griffith
1977; Lago and Thompson 2000).
Some authors offered training models to help therapists
work through their feelings (Ramon 2008; Thompson
1993). Others emphasized the essentiality of awareness and
working through cultural transference and countertransference
(Blue and Gonzalez 1992; Nuttman-Shwartz 2008;
Perez-Foster 1999; Schachter and Butts 1968; Ticho 1971).
Comas-Diaz and Jacobsen (1991) argued that this cultural
transference–countertransference dynamic could serve as a
catalyst for such major therapeutic issues as trust, ambivalence,
anger, and acceptance of disparate parts of the
self. Perez-Foster (1998) went further and argued that in
psychodynamic psychotherapy, both cognitive and affective
elements of the therapist’s cultural countertransference
matrix constitute factors in the therapeutic process that are
as powerful as projections produced by the client. She
identified four sources for this cultural countertransference
in the therapist: (1) American (or Western) life values, (2)
academically oriented practice, (3) personally driven idealizations
and prejudices toward other ethnic groups, and
(4) personally driven biases about the therapist’s own
ethnicity. Bodnar (2004) emphasized the last two factors,
arguing that analysts should be aware not only of their own
internal conflicts but also of their own cultural values. She
claimed that the cultures of the patient and of the analyst
should be openly acknowledged as another actor in the
psychoanalytic relationship.
One of the more sophisticated obstacles preventing
therapists from being sensitive to other races or ethnic
groups is what has become known in social sciences as
‘‘white privilege.’’ McIntosh (1988) defined ‘‘white privilege’’
as the ‘‘invisible knapsack’’ of unearned assets that
members of dominant racial groups cash in every day. It
includes easy access to social and cultural products that are
consistent with the majority group’s interest and are not as
easily accessible to the minority groups or are inconsistent
with their interests. More visible examples related to the
Arab minority in Israel are the assumptions that everyone
in Israel speaks Hebrew, that Saturday is the official day of
rest for everyone, or that all Israelis should have the same
ethnic enemy. Such ‘‘white privilege’’ allows the majority
to assume a homogenization of experience and less interest
in the experience of others (Stewart et al. 2012; Hastie and
Rimmington 2014). Suchet (2004) argued that a privileged,
dominant group (e.g., whites in South Africa) dissociates
itself from race subjectivity by becoming the invisible race,
a result of their inability to tolerate the oppressor parts of
their ethnic identity throughout history.
When discussing counseling and therapy of Arab patients
in the USA (Nassar-McMillan and Hakim-Larson
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2003; Sayed 2003) and in Israel (Al-Krenawi 1996; Al-
Krenawi and Graham 2000; Dwairy and Van-Sickle 1996;
Haj-Yahia 1995), political conflict is not often seen as a
major issue affecting the therapeutic relationship and the
treatment process. The authors usually try to study the
social particularity of the Arab patients, and suggest suitable
therapeutic approaches for Arab patients considering
their cultural background (Masalha 1999; Dwairy 2009)
but not the political conflict. Consistent with the ‘‘white
privilege’’ literature, this absence in the literature may be
attributed not only to the fact that violence and politics are
not politically correct, but that the ‘‘white privilege’’ effect
prevents this deep dialogue by assuming homogeneity.
Only recently have Western researchers begun integrating
political conflict into the issues that therapists must
address as an important part of the therapy when treating
Arab or Muslim patients. In the USA, Ericskon and Al-
Timini (2001) showed that the mistrust and fear of Arab
patients of their American therapists is often related to the
strong political alliance of the USA with Israel. Others
argue that when treating Muslim patients in the West,
therapists must be aware of the political forces and events
that affect these patients (Roysicar 2003). In England, the
awareness of the effects of Islamophobia on the therapeutic
process and the therapeutic relationship has been recently
reported, and are deemed central to therapy and an issue
that therapists must keep in mind (Davids 2006, 2008;
Guru 2010; Inayat 2007).
Reports from Northern Ireland suggest that therapists
usually avoid dealing with the implications of the Catholic–
Protestant conflict on therapy, although often they experience
intense countertransference reactions related to
the conflict (Benson et al. 2005; Campbell and McCrystal
2005; Campbell and Healey 1999). Similar experiences of
countertransference have been reported and discussed in
the Israeli context when the therapist is Jewish and the
patient is Arab (Bizi-Nathaniel et al. 1991; Gorkin 1987;
Yovel 2001). Strong emotions of anger, fear, and guilt in
the therapeutic space, when not discussed freely between
therapist and patient, render the dialogue superficial, with
no one acknowledging, ‘‘Hello, there’s a huge white elephant
sitting between us in this room.’’ After her experience
in mental-health work in the context of the Israeli–
Palestinian conflict, Nuttman-Shwartz (2008) argued that
cultural sensitivity was not sufficient during times of violent
political conflict and that continuous work on countertransference
issues related to the conflict is essential.
Furthermore, it is important to relate to the political events,
the history of the conflict, and the different narratives of
both sides.
Davids (2006, 2008) tried to explain the therapist’s responsibility
for this silence and avoidance in the
therapeutic room, claiming that the unknown and the
unfamiliar may become alien and hostile. Similarly, after
studying several violent political conflict zones worldwide,
Volkan (1997) argued that ethnic ‘‘enemy’’ relationships
are created when one large group projects and externalizes
the un-integrated and unwanted parts of its identity on
another large group and vice versa. The present paper argues
that, similarly, unwanted parts of the therapists’ ethnic
identity (hatred, inferiority, discrimination) may also be
dissociated and harm the therapy and the therapist’s ability
to feel empathy. Davids (2008) argued that, unconsciously,
Western therapists use colonial dynamics by allowing their
primitive anxieties to be projected on the unknown other.
In the case of Arab and Muslim patients in the West, the
therapist’s primitive anxiety is projected on the Muslim
patient as Islamophobia, which was re-enforced by the
events of 9/11.
It is noteworthy that all publications about psychotherapy
during violent ethnic conflict involve therapists
from the majority group and patients from the minority
group. To the best of my knowledge, no papers have been
published about psychotherapy when the roles are reversed,
and it is this unique situation that is the subject of the
present paper. The cases presented here describe a
therapeutic dyad in Israel where the therapist is a member
of the under-privileged Arab Palestinian minority and the
patient is a member of the privileged Jewish majority. The
absence of literature on this situation may be attributed to
the fact that most Arab therapists in Israel have less seniority
or fear openly addressing this complex issue. Furthermore,
professionals are trained to use language of
empathy and support, and this issue is ‘‘muddied’’ by the
therapist’s politics, racism, personal aggression, and hatred.
Jewish Therapist–Arab Patient
To begin the investigation of the Arab therapist-Jewish
patient dyad, some familiar therapeutic issues from the
opposite—more familiar and common—therapeutic dyad
should be reviewed: when the Jew is the therapist and the
Arab is the patient.
The first articles on this issue were published by Gorkin
et al. (1985) and Gorkin (1986) shortly before the beginning
of the first Intifada in 1987. Gorkin (1986) presented a
pioneering and deep discussion of this war-related transference–
countertransference dynamic. Gorkin, an American
psychoanalyst, had worked temporarily as a senior
supervisor in Israel, and it seems that coming from the
outside made it easier for him to open this very sensitive
political issue on the clinical level. He discussed some of
the more common countertransference issues emerging in
Jewish therapist–Arab patient dyads. One is that the Jewish
therapist may become over-curious about Arab culture,
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trying to learn what it means to be Arab, using this anthropological
curiosity as an unconscious defense
mechanism against the deep fear of close contact with ‘‘the
enemy.’’ Conversely, both patient and therapist may cue
each other and leave no space for differences in cultural
perceptions or for the political conflict to enter the
therapeutic dialogue. Gorkin (1986) also discussed various
manifestations of guilt and anger in countertransference.
Bizi-Nathaniel et al. (1991) reported a case study of a
Jewish therapist and Arab patient during the first Intifada.
They concluded that the violent political reality, like every
external reality reported in psychodynamic therapy, conveys
a deeper inner reality. But they also argued that the
realities of politics and war differ from any other reality
reported in therapy, as it is more threatening for both
participants, and narrows the potential space to take the
external reality material and work it out on deeper levels.
Shoshani et al. (2010) described how external political
violent threat (Arab–Israeli war in this case) limits the
ability of the analyst (Jewish Israeli analyst) to create a
reliable container in the analysis, even if the patient is not
an Arab but an Israeli Jew. They described two cases where
both patient and analyst were Jewish, and focused on how
the ongoing war outside the room raised feelings of shame
and fear, affecting the intrapersonal and the interpersonal
dynamics of both partners of the analysis.
Recently, Baum (2011) continued this transference–
countertransference discussion noting that the ‘‘enemy
presence’’ inside the room is a dominant issue for both
psychotherapy participants in the Jewish therapist–Arab
patient dyad. She emphasized the feelings of mistrust that
the Jewish therapist and the Arab patient feel toward each
other, as well as the guilt that Jewish therapists feel for
being on the strong side of the political and therapeutic
dyad. She also mentioned that when these feelings of
mistrust are not opened in therapy, the treatment alliance
remains very vulnerable. The therapist may think, ‘‘Does
he trust me? Does he really want me to be his therapist?
Can I be a good container for all his feelings? Do I really
want to hear his anger at me?’’ The patient may ask himself,
‘‘Does this Jewish therapist really want to help me?
Can he really understand what I am talking about?’’
Supervision is also affected by the Arab–Israeli conflict.
Haj-Yahia and Roer-Strier (1999) reported two separate
empirical studies: one of 20 Arab social work students; and
the other of 29 Jewish supervisors who supervised Arab
students in social work. In both studies, the participants
reported different parts of their supervision experience via
questionnaires. The results showed that this cultural difference
affects many levels of the supervision relationship.
Arab students expected the supervisor to be more of a directing
and teaching authority, and not only offer support
or be a partner for sharing thoughts. Arab students
experienced many of the helping therapeutic tools and
suggestions of the supervisor to be inconsistent with their
cultural expectations.
Rubin and Nassar (1993) discussed this supervision relationship
from a clinical point of view and described some
of the cross-cultural effects in the supervision context
where the therapist was an Arab woman treating a bereaved
Arab family under the supervision of an Israeli Jewish
senior therapist. The authors argued that developing trust
between therapist and supervisor in such cases is the main
key to getting through this political and cultural difference
professionally. Several obstacles may hamper this development
of trust: the therapist’s anger at the Jewish system,
possibly projecting responsibility on the Jewish state for
the patient’s poor mental health as a result of poverty and
discrimination against Arabs; being the only Arabic-speaking
therapist in the clinic, thus the only one who could
be assigned to this case, giving her the experience of
having no space; the unfamiliarity of the Jewish supervisor
with the Arab culture of both therapist and patients, which
could also act as an obstacle to building trust. Rubin and
Nassar (1993) argued that flexibility and open mindedness
is the best way to get the therapeutic triad (patient, therapist,
and supervisor) efficiently through this complicated
experience.
Arab Therapist–Jewish Patient
The following discussion is based, for the most part, on
clinical examples. Some of the therapeutic issues raised
may be familiar to every therapist regardless of ethnic
group, but I will emphasize the uniqueness of the Arab–
Jewish context as related to these therapeutic dilemmas.
In the Jewish therapist–Arab patient situation, the power
deferential in the therapy room is very familiar and similar
to the power deferential of the Israeli public arena (using
Hebrew as the privileged language, the Jewish person has
the professional knowledge etc.). Thus, Jewish–Israeli superiority
is maintained in and out of the therapeutic space,
a state of being that does not disturb the Jewish therapist
and is familiar to the Arab patient. However, this familiar
balance shifts when the therapist is Arab and the patient is
Jewish: the precious knowledge exists in the underprivileged
Arab person. This switch in the power deferential
between inside and outside of the therapeutic room
may be reflected in the therapeutic relationship in different
ways. The patient may distrust and refuse to accept help
from the person whom the patient perceives as inferior and
not trustworthy; and the therapist may overreact (at least in
phantasy) to this superiority as part of cultural transference.
A young Arab therapist reported his feelings when his
Jewish patient arrived early for a session:
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I saw him from the window trying to get in early
while the door was locked, I didn’t open the door and
didn’t let him in. ‘‘Let him wait outside,’’ I thought.
‘‘What does he think? If he is Jewish he can get in
whenever he wants?’’
I thought that the Arab therapist was saying ‘‘because Jews
invade my nation’s borders by occupation, I would not let
them invade my personal therapeutic boundaries.’’
The Therapist’s Ambivalence Toward Being
Different
Although Arabs have been living in this region for many
centuries prior to Israeli statehood, today we are a minority
that feels unwanted and unwelcome—in our own land. The
Arab population of Israel feels marginalized and not fully
accepted, and the Arab Palestinian narrative is not recognized,
pushing Arab citizens to prefer hiding their national
identity, or minimizing it to avoid conflicts or embarrassment.
Such avoidance may also be enacted in therapy.
Israel is a Jewish state, and neither Muslim nor Christian
holidays are official state holidays. Arab employees are allowed
to take vacation days to celebrate their holidays with
their families, yet some Jewish colleagues and patients are
surprised again and again every year when the Arab therapist
informs them about his/her holiday plans. Insecure young
therapists, who are not sure of their legitimate existence and
presence as a representative of ‘‘the other’’ or ‘‘the enemy’’
group, may try to minimize this ‘‘unwanted’’ presence, in
order to avoid anger, discussion, or even innocent questions.
One of my colleagues described this feeling: ‘‘I wanted to
finish my training period peacefully without many questions
and suspicions about my ethnic identity.’’
As a Christian, I take 2 days off for Christmas. In my
fourth (last) year of training, I decided to take a 10-day
vacation spanning Christmas and New Year. I informed all
my patients 3 weeks prior to the vacation, and although I
decided not to tell my Jewish patients why I’m taking this
time off, I inadvertently told one of them, ‘‘I’ll be away for
10 days and will have to skip two meetings while I’m on
Christmas vacation.’’ He was surprised that I was Christian
and said ‘‘I knew you are Arab because of your accent, but
I didn’t know that you are also Christian.’’ I avoided any
further discussion of the topic.
When we resumed our sessions, he was very angry and
unusually silent. I suggested that this reaction is related to
my absence. He agreed. I then asked whether he had experienced
such feelings during my previous vacations
during his 2 years of therapy, and he said no, because
during previous vacations, the clinic had been closed because
of the Jewish holidays which are his as well, but this
time he and the clinic were available but I was not.
At one point in this session, he said in a quiet tone,
trying to hide his anger, ‘‘I immigrated to this land in order
to feel at home and not to have strangers controlling my
schedule.’’ For a moment, his reaction made me angry, and
I thought to myself, ‘‘You bastard. You immigrated to this
land as a stranger in order to have a home, and you’re
preventing me from having my own national home.’’ I then
took a deep breath trying to force myself to think differently.
After a while I said, ‘‘Probably you want me to be
your family and your home, to be very similar to you, and
to have the same holidays as you.’’ This empathic intervention
of mine was possible only because I was secure
enough of my right to be different, even if that may make
others angry.
This incident led to his talking about his family, immigration
experience, and his desire to be part of Israeli society.
These wishes are very similar to my wishes to be
recognized by Israeli society as legitimately different
without having to apologize for my national identity. For a
while, my patient and I seemed like two enemies fighting
for the right to exist, which is a very legitimate act on the
political sphere outside the therapeutic space, but on the
symbolic, humanistic level, we both were seeking to meet
the same need of being seen and accepted.
Ambivalence about national identity may interfere not
only in therapeutic relationships but also in feelings toward
staff, affecting relationships with support and supervisory
professionals. On the day Yasser Arafat died, I thought to
take a day off, as did many Palestinians out of respect to
their national leader, but I reconsidered and went to my job
in one of the public mental-health clinics, holding my tears
inside me. When I entered the clinic I heard some of my
junior colleagues talking joyfully and sarcastically about
Arafat’s death. I felt insulted and very lonely the entire day,
and did not have the courage to talk with any of my Jewish
colleagues about this insult (at the time I was the only Arab
working in the clinic). I did not feel confident about how
my Jewish colleagues would accept my sadness over
Arafat’s death while Palestinians were bombing Israeli
buses on a weekly basis.
Baum (2010) reported similar dynamics of Arab–Israeli
professionals whom she interviewed after what she called
‘‘terror attacks’’ by Palestinians. Arab professionals who
had close friendships with the Jewish staff felt a lot of
confusion and tension, while those who did not felt that
they had to keep their distance after a violent attack on
Israelis.
Choice of Language
Hebrew is Israel’s first formal language, with Arabic and
English second and third. In fact, very few Jewish Israelis
know enough Arabic to hold even a basic conversation, and
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those who know Arabic usually prefer not to speak it. All
Arab therapists use Hebrew with their Jewish patients and
Arabic with their Arab patients, which I also did for a long
time, accepting the status quo of Hebrew as the privileged
language. Then, a Jewish patient, who had emigrated from
the USA 2 years prior to our first meeting, asked me
whether I could handle the therapy in English because his
Hebrew was not good enough. I agreed, giving it not much
thought. Later, I began asking myself why I do not have
courage that this Jewish American man has, to discuss the
language of therapy with my patients or supervisors. I realized
that the unfair status quo of the Israeli street, where
one language is more acceptable and privileged, has also
entered the therapeutic setting, without any thought being
devoted to it.
However, nothing is one-sided, and neither am I. When I
choose to put aside my mother tongue, Arabic, in favor of
speaking with my patients in their language, I feel that my
choice welcomes and invites a close relationship.
Between Fear and the Wish to be Loved
Usually, Jewish patients recognize the national identity of
the Arab therapist by his or her name, but if—as in my
case—the name is not typically Arab, the next clues to
nationality are our accent in Hebrew, hearing us speak
Arabic, or through more subtle signs. No matter how they
learn about our nationality and regardless of the stage of
therapy, when our patients do recognize it, they try to localize
the national differences between patient and therapist
in a place that does not threaten their ability to trust the
therapist and to surrender to the therapy. This type of unconscious
search by the patient to find a midpoint where he
can bury in order to trust the therapist is usual also in
therapeutic dyads where the therapist is Jewish and the
patient is Arab (Baum 2011).
My first patient, when I was a young student of clinical
psychology, was an Orthodox Jewish man in his 40s. He
opened our second session by saying in a very serious tone,
‘‘Two weeks ago, when we spoke on the phone to make our
first appointment, I heard your accent in the letters R and S,
and thought you’re Romanian or Russian Jew, but when we
met and I saw you face-to-face, I was sure that you are
Druze. But when you were locking the door last week and I
saw the picture of Jesus on your keychain, I became sure
that you are Christian. But I’m sure that you’re Greek
Orthodox because Catholics did so much bad to Jews in
Europe, and you are not like them.’’ As matter of a fact, I
am Catholic, but the important thing here is the mental
effort that this patient made in order to categorize me in
some narrow category that fit his reality and was not too
frightening for him.
My Arab Identity as Self-Object for the Patient
Not always does my Arab nationality invite difficult feelings
and negative transference–countertransference dynamics.
Some patients can use my being different in order
to project those positive feelings that they could not find in
their natural developmental environment.
For example, a young Jewish Israeli man was referred to
me in one of the public-service clinics. When I asked him in
the first session how it would be for him to receive an Arab
therapist, he answered, ‘‘I feel more comfortable here with
you being Arab than if you were a Jew.’’ He realized my
surprise and continued, ‘‘I hate this kibbutz I live in and this
whole damn country, and I don’t want to go to the army, so
you may understand what I want better than any Jewish
therapist.’’ Later in therapy, I learned that this young man
had been raised by a mentally ill mother while his father
lived far away. His anger at the state and the kibbutz
symbolized his non-legitimized anger toward his parents,
and he created a split between me as a helping, containing,
reasonable caretaker and the painful rejecting one.
Patients also use my Arab identity in a positive way by
turning it into a transitional object during termination.
A 40-year-old Jewish woman with a dependent personality
came to the termination of the therapy after
2 years of twice-weekly psychotherapy, held totally in
Hebrew. At one of the last sessions she described how
difficult it would be for her to live without these sessions.
Suddenly she said ‘‘Do you know that lately I went back to
watching Arab TV channels?’’ When I tried to understand
this, she told me something I had not known previously—
her parents, who had immigrated to Israel from Arab
countries—spoke Arabic at home when she was a child.
She also said that hearing Arabic calmed her and made her
feel that I am still around although she had never actually
heard me speaking Arabic.
Objective Anger and Guilt
Winnicott (1949) described Objective Hate in therapy as
those very strong negative feelings that therapists feel towards
patients. These feelings are legitimate, and the
therapist cannot avoid feeling them in specific circumstances
during therapy. He argued that without recognizing those
feelings and giving them legitimacy, empathy cannot be
sincere. Such negative feelings can easily be raised in therapy
during times of violent political conflict, or during periods
of great pain- and aggression-based inter-group
relationships. Violent political conflict is also a time when
the parties in therapy may project dissociated parts of one’s
own identity and acting according to a split mechanism
(Volkan 1997), especially when this conflict is still active,
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bloody, and long term. Values associated with war, such as
killing, revenge, and hatred, are very contradictory to the
therapeutic values of caring, empathy, and enabling. When
Palestinian and Jewish people meet in the therapy room,
these two types of values must coexist, both in fantasy and in
reality. Many times, this conflict of values can be held in the
back of the mind and not become central in the therapeutic
relationship. In other cases, the painful political reality enters
the therapeutic room in a direct way, through primitive
anxieties. When that occurs, transference–countertransference
dynamics can strongly resonate within therapist and
patient, narrowing the interpersonal and intrapersonal potential
space to the point of reaching an impasse.
A Jewish woman in her late 60s came to my private
clinic. She complained of mood instability since the killing
of two of her relatives in a suicide bombing of an Israeli
bus by a young Palestinian man 5 years earlier. During our
first two sessions, the patient described in detail her sorrow
and pain after the loss of her loved ones, she also recalled
many anti-Jewish events she witnessed as a teenager and
young student in her native European country. After
hearing all these painful and insulting experiences, I
commented ‘‘You’re describing a very painful thing
Palestinians caused you because you are Israeli, and many
other insulting events Christians caused you as a European.
Here you are in Israel choosing to meet a Palestinian,
Christian therapist, even though there are many other
Jewish ones that you can easily find. How come?’’
Her answer was very rational and intellectualized: ‘‘I am
a very humanistic person and believe in the good will of
humans regardless of their religion or nationality.’’ I chose
not to confront this issue anymore during therapy, believing
that such a conflictual issue is bound to return one way
or another. Surprisingly, the issue of loss and the suicide
attack was not central during the weekly sessions for the
first 3 months, but was only mentioned from time to time.
The patient was more preoccupied with her relationship
with her parents during her childhood and about the
poverty in that period of life. She also discussed her present
relationships with her colleagues, the way she is managing
her profession and her relationship with her new partner.
When talking about the loss of her relatives, she spoke
in a non-emotional way. Although she was not dramatic
and emotional in describing her experience of the suicide
attack, the story of the loss made me imagine losing my
loved ones and feel a bit of fear. I tried to use these feelings,
saying to her, ‘‘It must be very frightening and
shocking to lose two loved ones in 1 day out of nowhere.’’
But this did not help her to express her emotions differently.
After the third or fourth time, I said similar things to
her, and then an additional thought came to my mind.
‘‘Would it be the same for me to lose my loved ones in a
car accident or through political violence or to disease?’’
This time I did not feel only fear but also anger and
helplessness, and sensed tears starting to fill my eyes. I held
myself, stopped my thoughts, and tried to concentrate on
what she was saying. For the first time, I heard her talking
in a slightly angry tone about the death of her relatives and
saying, ‘‘I lost both of them in a stupid bombing, and nobody
is even apologizing or feeling shame about it.’’ At
that moment I understood this sentence as anger at Israeli
government and a society that is ignorant of the very strong
pain she is experiencing while others continue their lives as
usual.
Two days later, I recalled this sentence and suddenly
experienced it differently, ‘‘Roney, I lost them both in a
stupid bombing and you don’t give a shit about it, and you
aren’t even apologizing or feeling shame about it.’’ I
thought that she is right. I feel sorrow for her loss as if she
had lost her loved ones in a car accident. But this cannot be
the only feeling. Something wrong is going on here—the
person who killed them is a young Palestinian man, just
like me. This made me think that, for me, it must be different
to hear her talking about losing her loved ones in a
suicide attack than in any other way. ‘‘Should I really
apologize for what happened to her? Do I feel guilty or
responsible for that in any way?’’
I had to get up a lot of courage to answer the core
question underlying these thoughts, ‘‘As a Palestinian living
in Israel, what do I really think and feel about suicide
attacks?’’ It took me a while to deal with this question
within myself and with my Palestinian friends, but not with
my Jewish supervisor. I felt afraid that I might sound too
aggressive to him if I am not fully humanistic. For 2 or
3 weeks, I had many internal dialogues with a hypothetical
suicide attacker. Today, I may summarize these dialogues
in this way, ‘‘Dear attacker, I do not know if you are a
terrorist or a resistance fighter fighting against the occupation,
doing your national duty. I do respect your courage
to die for Palestine, something that I would never do for my
nation, not only because I am not brave enough, and not
only because I do not love Palestine as much as you do, but
also because I care for those who were harmed. I also do
know how painful your life in the West Bank is, for I
worked there as young psychologist for a while. I know
how much anger you and I have for those who continue to
kill, defeat, and insult us on a daily basis, and how much
hope we both have for our nation. But still, I cannot feel so
sad for those Jewish fellows, colleagues, and patients who
really suffer from what you did. I also suffer seeing all of
us suffering, and I suffer from not being able to decrease
neither your suffering nor theirs.’’
Being able to see this complexity and to experience the
whole range of feelings on both parts of this conflict enabled
me to hear this patient differently and, in a later
session, say to her at an appropriate moment, ‘‘A few
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weeks ago you said that nobody apologized or felt guilty
about it. Probably you want me to feel guilty about what
happened to you?’’ She answered immediately, ‘‘No, why
you? You didn’t do it.’’ Then, after a short silence, she
dealt with this differently, saying angrily ‘‘Yes. I want
Arabs to know how bad they are. They always complain
and cry about them being occupied, but I, and others, have
similar pain, if not greater.’’ After hearing this anger, I
could say ‘‘Yes, it may be comforting if you knew that
those who harmed you that much recognized and felt sorry
and pained for what they did.’’ In my experience, this
working through of mine was the only way to enable the
melancholic process of this patient to start.
Aggressive Fantasies in Countertransference
to Empathy
The next case description is another example of how objective
hate or anger may cause unbearable ambivalence,
harming the therapist’s ability to feel empathy.
A teacher in his mid-30s was referred to psychotherapy
in a public clinic by his psychiatrist. He came with psychosomatic
symptoms and narcissistic, obsessive personality
characteristics. He was a new immigrant from the
Ukraine, and although Hebrew was not his mother tongue
and he had a clear foreign accent, he spoke Hebrew well
enough to handle psychotherapy. Very quickly, he became
over-committed and surrendered to therapy as part of his
dependency needs. After 5 months of weekly sessions, I
sent him back to his psychiatrist in order to re-examine the
option of stopping or decreasing his medications. In the
session after his visit to the psychiatrist he said:
Patient (in an embarrassed, but also angry, tone): Is it
true that you’re an Arab?
Me (surprised and panicked): Yes. How come you’re
asking me now, after 5 months of knowing each other?
Patient: Because I didn’t know it before
Me (feeling as if I cheated him): And how did you know
that now?
Patient: When I visited the psychiatrist, she asked me
how I feel with my psychotherapy. I said, ‘Great and feel
very helped and free of stress.’ She said that she
expected that because ‘although Roney is an Arab, he is
a good therapist and able to help.’
For the first second, I felt betrayed and was upset at my
psychiatrist colleague for I experienced her saying between
the lines, ‘‘Usually Arabs are not good in doing things, but
unusually Roney is good although he is an Arab.’’ After a
while I asked myself, ‘‘Is that what she really said, or was it
what my patient wants to say, or what he experienced her
saying. Did she really say it?’’ Being surprised and feeling
insulted got me stuck too deeply in reality during the
session, and my thoughts were very concrete as part of a
split mechanism as a reaction to anxiety. I tried to disentangle
myself from this loop and said:
Me: How is it for you to know that I am Arab?
Patient: I have no problem with that, although I am a
settler, I have an Arab friend (he paused, and probably
saw my facial expressions changing hearing that he is a
settler). I used to live in settlements, but today I do not
because it’s not comfortable and it’s far from my
workplace, but I still believe in the settlers’ ideology of
the Jewish right to control the entire Holy Land.
This clearly and directly triggered my painful national
feelings. I quickly realized that we had both surprised each
other with ‘‘bad’’ facts, and that we do not trust each other
as we had before. It became clear to me that something
different and not easy was going to happen here, but I had
no idea what and how I should handle it. Indeed, the next
few sessions were repetitions of issues we had discussed
before, but the patient spoke in short sentences, was less
sharing, and I felt very concrete and not able to think
freely. I also felt shame and fear of sharing all this with my
supervisor who was Jewish and, who I thought, was
ideologically right wing. I did not feel safe of what she may
think and how she may react to or judge my feelings and
thoughts.
Memorial Day for Israelis who died in action came
2 weeks later. At 11:00 a.m. on Memorial Day a siren is
sounded all over Israel, calling everyone to a 2-min
standstill. For me, as for most other Arab Palestinians
living in Israel, this day is very embarrassing and confusing.
We feel unease standing in respect of soldiers who
killed our people and moved others to refugee camps. In
previous years, I made sure not to be in public at the time
of the siren so I would not feel embarrassed and not insult
the Jews who feel they must show their respect.
That year I had my therapeutic session with my therapist—
who was a Jew—on Memorial Day. Our session was
to end at 10:50, 10 min before the siren. The issue was
raised during the session, and I told her I planned not to get
up from my seat on the bus. She tried to hint to me that
such an act might be dangerous, because unlike on campus,
people on the bus might be fanatical and could act violently
toward me if I remained seated. I heard but went on with
my plan. The siren went on, the bus stopped, everybody
stood still, and I kept seated, trying not to look people in
the eye. No violence ensued. At the next session with my
therapist, the Israeli–Palestinian issue was central. She
tried to say something empathic, like ‘‘I can understand
how angry you are at Jews.’’ This empathic comment made
me angrier and I directed my anger directly at her rather
than at Jews in general, so I said ‘‘How can you understand
my anger when your kids go to the Israeli army, keep
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killing, and stand at checkpoints insulting Palestinians?
How can you claim to understand while you live in a
neighborhood which is occupied from Palestinian people
who were kicked out of their houses? You know, if it
happened that your son and I were standing face to face on
the battlefield, we would have no mercy for each other.’’ I
have no idea what she thought, but after a while she said
‘‘Yes, it is very hard to believe that I can understand when I
don’t change my life.’’
During the next week I thought to myself, ‘‘What do I
want from my therapist? Why am I making life so hard for
her? She’s treating me at a discounted price because I’m a
young therapist, and she tried to protect me from facing
violence on the bus, and has been very available to me for
several years already. Should she change her life in order to
satisfy me?’’ I also thought ‘‘What did I want from people
in the bus? Did I want them to understand how much pain I
am in? How different I am? To know how bad their soldiers
are? Why do I want to tell them that?’’ These questions
had no clear answers then and still have none today,
over a decade later. They only helped me to read and integrate
the Israeli–Palestinian conflict differently both in
the national and the personal levels.
After processing this anger via therapy, I was able to
experience my patient in more integrated way, not only as a
threatening settler, but also as a similar human being. In
one of the sessions, he was describing his immigration
experience: He was in his late 20s when he left the
Ukraine, and found Israeli society unwelcoming and discriminatory.
He also described how angry he was at Israelis
for being impolite and bullying, ‘‘They don’t stand on line,
they don’t say sorry or thank you.’’ This was very different
from the culture he left behind. After feeling happy that I
was not alone at being angry at Israel, I realized that
although we are enemies on the political level (because he
is a settler and I am a Palestinian), we have a few things in
common related to the same cultural conflict. I said
‘‘You’re telling me, an Arab person, how angry you are at
Israelis, and I think that we both live on the margins of this
society, and yet we both speak Hebrew when we meet even
though it’s neither of our mother tongues.’’ He was surprised
to see that we had something in common related to
Israel. He went on to describe his feeling of being culturally
marginalized and feeling a kind of urge to apologize
all the time for being a stranger.
I thought to myself: I dealt with this marginalizing by
Israeli society by fighting back angrily and provoking my
therapist and other people on the bus, but probably, my
patient is dealing with this marginalization differently, by
over-conformance to Israeli society. I thought that coming
from the Ukraine, believing in the right of Jews to settle in
the West Bank is probably like trying to be more Catholic
than the Pope in order to be accepted into Israeli society. I
was not sure about this idea, so did not say anything about
it. I was not sure about this idea because I was afraid that I
am trying to force my ideas of myself on this patient in
order to be able to feel empathy toward him.
In the coming sessions, he started to recall memories
related to being Ukrainian living under the Soviet regime,
and being urged to give up his native language in favor of
Russian. He recalled how he was one of the very few
university students who spoke high-level Ukrainian,
although he was Jewish Ukrainian and not Christian. He
also recalled how he helped destroy the communist symbols
in the Ukraine after liberation. Again, although Jewish,
he chose to be more Ukrainian than mainstream
(Christian) Ukrainians. It was also very painful for him
that, a few years later, Ukrainian society started to discriminate
against Jews, which gave him the idea of immigrating
to Israel.
I commented on this style of fighting to become part of
Ukrainian society and being over-loyal to it while, by
definition, he was neither part of the mainstream nor a
typical member of this group. This comment led him,
2 weeks later, to open a family dynamic of loyalty and his
wish to be part of his own family as a kid, while both his
parents were preoccupied with their emotional needs and
not loyal to his. This dynamic caused him to be overdependent
on others in order to gain closeness and love,
and—to pay the price of being over-loyal to others to gain
their acceptance.
Summary and Conclusions
In this paper, I tried to describe specific transference–
countertransference issues that face Arab therapists working
with Jewish patients, who are members of two enemy
national groups where the therapist’s group is defined as
inferior and underprivileged, both politically and socially.
All of the vignettes reported above are examples of how the
internal emotional needs and primitive anxieties of both
members of the therapeutic dyad are projected on the
ethnic identity of the other during violent conflicts (Volkan
1997), creating transference–countertransference dynamics
that may harm the therapy. Similar reports can be found
about the opposite dyad—Jewish therapist and Arab patient
(Baum 2011; Gorkin 1987). I also tried to describe how this
transference–countertransference dynamic can be worked
through in order to prevent it from being an obstacle to
therapy, and making it a unique sensor in the therapist’s
mind that might enhance the ability of the therapist to
contain the unthought known (Bollas 1987) materials of the
patient and of the therapist him/herself. I tried to show how
this national political conflict may interfere with the
therapeutic relationship during different stages of
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therapy—at the beginning, during termination and
throughout the deep work of interpretation in the middle,
and during termination—and in different ways and over a
variety of issues.
The main argument in this paper was that, on the one
hand, when issues of war or any other violent political
conflict are raised during psychotherapy sessions, they are
like any other issues of reality, usually reported directly or
via transference, and they convey other internal, deeper
material (Bizi-Nathaniel et al. 1991). On the other hand,
working through war issues has many unique traits and
difficulties (Baum 2011; Gorkin 1986). When the therapist’s
national group is part of this war, his/her potential
space for taking this war-related material playing with it to
allow further thinking beyond the reality is limited. The
therapist and his family are not only physically threatened
by the war events, but also emotionally vulnerable. The
therapist has a lot of anger and guilt, defeat, insult and
other emotions that threaten his/her self-image and the way
s/he wants his large ethnic group to be perceived in his
mind and in the others’ minds. This preoccupation during
war time is correct for the psychotherapist no matter who
the patient is (Shoshani et al. 2010). However, when the
patient represents the enemy group in the therapist’s mind,
this conflict becomes much more tense and very hard to
ignore or handle (Baum 2011; Benson et al. 2005; Campbell
and McCrystal 2005; Campbell and Healey 1999;
Gorkin 1986; Gorkin et al. 1985).
For example, when a Jewish therapist feels guilty that
his nation occupies Palestinian territories, he is not
physically threatened. What is threatened is his idealization
of his nation as moral, and that makes it hard for him to
hear the suffering of his Palestinian patient (Gorkin 1987).
The Jewish therapist’s desire to see his nation as moral is
similar to that of many other Jews. However, in psychotherapy,
morality, ethics, and empathy are part of humanistic
values integrated in the professional identity, so
the conflict is stronger. This is equally true for the Palestinian
therapist: I could not hear my patient grieving over
her two loved people after the suicide attack because I
could not handle seeing my nation as murderers; rather I
preferred to see my people as victims only. In the other
case, I could not contain my settler patient’s need to belong
because I over-identified with my nation’s defeat and suffering,
which I acted it out on the bus and with my
therapist. Further, in the case of the Palestinian therapist, it
is harder to work through this conflict because the Arab
narrative and feelings toward the Arab–Israeli conflict receive
less legitimization in Israel, and can rarely be freely
opened in supervision (Rubin and Nassar 1993).
While some authors suggest cultural sensitivity and
open-mindedness in supervision as a method to help the
Arab therapist get through these difficulties (Rubin and
Nassar1993), I maintain that more internal work is needed.
Part of this work can be done through supervision, and I
suggest that the best way out of this countertransference
stuckness is to integrate different and less-preferred parts
of our national identity, which would make us more
available to different parts of the patient’s national and
personal identity, and better containers for their unthinkable
materials (Bion 1970). A main obstacle to this integration
during wartime is that the vast majority of the
therapist’s nation is in a defensive and splitting mode as a
response to the war situation, while the therapist must
continue alone, not as a part of the collective national effort.
This loneliness may sometimes be experienced as
‘‘betraying my people by sympathizing with the enemy.’’
For Arab–Israeli therapists, the case is further complicated
by the fact that this integration work has to be done with
the help of other Jewish senior professionals (supervisors
or therapists) who themselves often cannot contain several
parts of the young Palestinian therapist’s national identity,
especially the aggressive and revenging parts of it.
Another source of transference–countertransference dynamics
that is specific to the context of therapist from the
minority group, is to identify unconsciously with the majority
group (Suchet 2004). In the therapeutic room, when a
therapist from the minority group and a patient from the
majority group meet, their interaction echoes that of the
public sphere, which accords many unconscious privileges
to the majority group (Hastie and Rimmington 2014;
McIntosh 1988). Gradually, the therapist begins to feel that
he is bending too far toward the patient out of force of habit
and without feeling that there is freedom to think or act
differently. This narrowing of the therapist’s space may
cause him much anger and helplessness that is not fully
processed or of which he is not aware.
When starting to write this paper in 2010, I considered
writing it in Hebrew in order to make it more available to
the Arab and Jewish Israeli therapists who face these issues
more often and closely. Later, I decided to publish it in
English so it would be accessible to therapists in other
areas of conflict, as it provides a very rare example of a
minority therapist using his national ‘‘inferiority’’ to help
and enrich his therapeutic work with patients from the
majority ‘‘enemy’’ group. I also want to share my personal
belief that peace can be advanced only if both parts of any
national conflict each integrate the different parts of their
own national identity without idealization or victimization
of themselves, at the same time reaching out to those on the
other side of the conflict.
In line with Gorkin (1986, 1987), some of the clinical
material presented in this paper showed how the political
conflict could easily function as a factor that cracks the
container in the therapist’s mind and in the therapeutic
room, giving the feeling of stuckness. In other cases, this
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issue functioned as ‘‘an elephant in the room’’—not
harmful but very voluminous. When the feelings of anger,
guilt, insult, shame, rejection, fear, and ambivalence are
given space and worked through, they may cease to be
obstacles and even function as strong and unique sensors to
improve empathy and contain thoughts, giving them unique
meanings in the patient’s experience. I found the controversial
phrase of Objective Hate (Winnicott 1949) very
useful in helping me work this countertransference
through. Hate and anger are unpreventable experiences
during war and political conflict, so they are ‘‘objective’’ in
many ways. Without recognizing this aggression and hate,
empathy can hardly develop when the ‘‘enemy’’ is sitting in
front of you.
In order to go through these therapeutic dilemmas professionally
and efficiently, Haj-Yahia and Roer-Strier
(1999) suggested that supervisors should be knowledgeable
and sensitive to Arab students’ cultural and political nuances.
Rubin and Nassar (1993) suggested that the main
tool is to develop trust between the Arab therapist and the
Jewish supervisor, in addition to flexibility and open
mindedness. Baum (2011) argued that processing and
working through these war-related emotions that were
initiated in the therapist is essential for handling therapy
with a patient from the opposing side of a violent political
conflict. In this paper, I strongly argue that therapists
should work on integrating different and difficult parts of
their national identity (including aggressive and violent
phantasies), and use these feelings that emerge during
therapy to communicate with the deep unconscious content
in the patient’s mind. In order to integrate these national
identity parts with the professional identity, profound work
should be done in supervision. Many times this is not
possible or insufficient in the supervision, for it may concern
the therapist’s or the supervisor’s personal beliefs. In
these cases, dialogue with peers from the same national
ethnic group may help the therapist (especially a young
therapist) to confirm and start working on these unthought
known contents related to war and national identity. Even
more awareness and thoughtfulness should be devoted to
these issues when the therapist is from the minority group
because the de-legitimatization of the minority narratives
during war may make it more difficult for therapists from
the minority group to do this deep internal work.
This paper may be a pioneer for further work needed to
describe the clinical work of other Arab therapists in Israel
or therapists from other minority groups during war,
making it possible to generalize some aspects of this
unique dyad. Further work is also needed to describe supervision
relationships when the therapist and the supervisor
are from conflicting groups and the patient is part of
the therapist’s or of the supervisor’s group (Baum 2012).
Conflict of interest The author declares that he has no conflicts to
report.
Ethical standard The author declares that informed consent was
obtained from all patients for being included in the study. And no real
identifying information about patients is included in the article.
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Dr. Roney Srour is a Palestinian clinical and educational psychologist,
born and raised in Galilee and Israeli citizen. He received
his academic degrees from the Hebrew University of Jerusalem. He
practices psychotherapy with adults and children in public and private
clinics in Haifa, Israel.
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