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

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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

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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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