Torture and Cultural Sociological Differences – Balkan and Non-Balkan Experience

Introduction

Unfortunately, various forms of abuse and torture have always existed. In times of war and peacetime. The malignant creativity of those intoxicated by their own aggressiveness can take incredible forms. Part of this article deals with the experiences of tortured persons during the war in the former Yugoslavia. As a symbol of this, a therapeutic group of persons will be shown who, during a year and a half of the group process, managed to re-establish trust in kindness and humanity, even though they had the right to be bitter about the human race all their lives. The second part of the text refers to torture at the borders of today’s modern European states. These are migrants from the Middle East who, due to poverty, regime repression, civil and interstate conflicts, set out for Europe in search of a safer life or wanted to be reunited with family members who had already fled. A third population will also be described, experts who are not from the group of medical assistants, psychologists, sociologists, etc. These are the translators who are the first to be hit when registering migrants and who are continuously flooded with massive terrifying content from deeply suffering people.

Torture in the Former Yugoslavia

Psychotherapeutic work with victims of torture is full of challenges and very demanding for the therapist. Through 54 sessions, 27 men with different levels of vulnerability and initial position of “permanent helplessness” successfully worked through their paranoid anxieties, established and developed cohesiveness and a certain group culture through several phases of group work. By doing so, they provided themselves with a path to the stage of opening, then working through their fears for their own psychophysical integrity through hypochondriacal elaborations, and then they found the strength to willingly face the traumas they had suffered again. They were able to reintegrate those experiences into themselves through the reintegration phase, and finally – through termination, to round off and give meaning to their emotional turbulence brought by therapy, and the end of therapy itself.

Forming a group and modifying the therapeutic technique

All members of the group had the experience of psychophysical torture during captivity. In the course of hostilities during the war on the territory of the former Yugoslavia, they were captured, after they accepted to surrender. Their comrades who refused to surrender “were never seen again”. This moment was of particular importance for their future psychological dynamics. Similar to the phenomenon described in Vietnam veterans, the death of a close friend was not perceived as the loss of a special person but as the loss of a part of the self (via narcissistic identification). This type of identification deprives the memory or representation of a dead comrade and is the basis for much of the unresolved pathological grief among war veterans. It is related to deep feelings of regret and guilt (Shatan, 1973). Van der Kolk (1987) states that soldiers with PTSD experience the death of another as a narcissistic injury rather than as an objective loss. They see their companions as an extension of themselves, not as separate individuals. This results in a strong need for revenge. One of the main benefits of group psychotherapy is precisely the ability to give up such pathological identifications.

In addition to being prisoners of war, some of the group’s members also had the experience of being abused by the police and paramilitary formations. Namely, after they fled to Serbia, they were arrested and treated as traitors. Those who were handed over to the paramilitary formation were imprisoned and subjected to psychophysical torture by their own compatriots, and then taken to the battlefield.

In addition to psychotherapy and classic psychiatric help, the group was offered legal and medical help. Group members could also have individual conversations. Meetings were held once a week for one and a half hour. The group worked for 18 months.

Most of them were captured together, or voluntarily surrendered since they were surrounded by the enemy army. In the end, they found themselves together in the same living space after surviving numerous traumatic experiences brought about by war, war captivity and refugees. All this created a kind of cohesiveness among them, but this cohesiveness at the same time made it difficult to communicate with the outside world and colored the group with a touch of autism. It was difficult to allow access to new members, women (there are no women in the group).

Another aggravating element was the fact that they all started legal proceedings against the state. However, as a result of unrealistic expectations and mutual disagreements, non-cooperation and reduced efficiency, none of these lawsuits progressed. Motivation was declining, and everyone was convinced that a positive outcome of those trials was completely impossible.

Freud believed that the symptoms he observed in World War I veterans were related to a condition he called “injured self-love.” From this point of view, the so-called the “permanent helplessness” of many Vietnam veterans, which rests on the absence of belief that things can ever change. This can explain the observation that the motivation for work in this group was initially related to legal benefits. It was very difficult to overcome the resistance to work on personal improvement.

At first I thought that the only possible approach to such a group was sociotherapeutic. However, it turned out that the group has the capacity for a modified group-analytical approach. Thus, over time, sociotherapy increasingly gave way to work that had the characteristics of a group-analytical approach.

The start

The first sessions took place in a rather unpleasant atmosphere. The contents were mainly about expressing anger towards the system, politicians and doctors who “did not provide adequate help”. While they vented about it, I got the impression that everything they were talking about happened very recently, not many years ago. Such a countertransference feeling helped me a lot to understand how these people fundamentally feel. The experience of torture led to the intensive use of appropriate psychological defenses in order to reject depression, guilt, shame and helplessness.

Affective regression and cognitive exhaustion lead to increased use of primitive mechanisms such as denial, splitting, and projective identification. Torture is also seen as a psychological construction where the individual is put into a state of extreme infantile helplessness, faced with the absolute ruthlessness and omnipotence of the persecutor. Although these people are now far from difficult and tragic events, materially and existentially situated, the fears remain the same – as if the trauma was still there. They openly told me that they had no reason to believe me, that they had been “deceived several times” so far, that their lawsuits against the state had been pending for years, that “society only abused them” and that the doctors dismissed them. Of course, I was not comfortable listening to how they attacked me and that they currently saw in me all sorts of figures from life with whom they associate neglectful and manipulative behavior. However, I was pleased with the fact that they continued to come to the sessions, talking about how after the traumatic experience of captivity and torture, it was difficult for them to maintain any kind of relationship. I don’t think at first they were even aware that they were now able to do just that – to maintain a relationship and to do something as a group.

Opening

After ten sessions, the positive effects became obvious. Gradually they stopped attacking me and the system and started to talk about themselves. They talked about the experience, that although they have been living together in the same place for years, they never communicated with each other or met in a group like now. They felt alienated, they passed each other and talked “on the way, briefly and superficially”. The veterans finally felt that they had found a place for empathic reflection. It was very striking how fixated they were on the idea that their lives would never be able to progress spontaneously without some extensive outside help. They conveyed to me the feeling that they urgently need help and that injustice is all around them.

The sessions went on, and none of them still talked about the traumatic experience of torture. I did not force it, I was waiting for the moment when the atmosphere in the group would be ready for such a thing. Soon, an atmosphere began to develop that indicated that the problem of opening up to others, which stems from the complicated and perverse relationship between the torturer and the victim, is slowly being overcome. Now there was space for me as a therapist to be experienced as someone in the role of a benign authority, which will enable a catharsis free of prejudice and rationalization.

Hypochondriac elaborations

In the next phase, the contents of the sessions were full of expressions of fears for their own health. Everyone started asking about medical institutions where they could perform appropriate tests. I used the opportunity to support health care for those who really needed it and help them become aware of self-destructive aspects of their own behavior. These were those who, despite their somatic complaints, did not want to see a doctor, e.g. they did not pay attention to long-term elevated blood pressure, or they increasingly resorted to the use of alcohol and thus solved the problems of insomnia and increased tension. In addition to real concern about health, some of the group had obvious hypochondriacal elaborations. Even after many analyzes and examinations that were within normal limits, they were still looking for the disease. In this phase, interpretations of the type: “It seems that after a long period of real danger and danger that came from outside and that is no longer there, now there seems to be a need to look for danger in the body and that’s why they were afraid of illness”. For several sessions, hypochondriacal fears were worked through, which then opened the way for one of the most impressive stages in the group’s work, which was the working through of traumatic experiences from the camps where they were imprisoned.

Torture “again”

In subsequent meetings, they did not hesitate to present even the most difficult details of how they were tortured. They spoke first about the conditions in which they survived in the camps; that they slept on concrete or some straw, that they had a poor diet and were exhausted by work. They were humiliated in many ways – locked in doghouses and forced to bark, to literally graze grass, to beat each other. They experienced beatings with different objects – most often with baton and canes. They would be tied and placed in a position to hang upside down, or their extremities would be tied with rope, and then the rope would be tightened by the torturer at different time intervals. They were threatened with death, as well as the death of their families, they were taken to mock executions, they witnessed sexual abuse and even murder. Some had a gun pressed to their head and fired point blank.

I mostly listened, occasionally connected content related to the feeling of humiliation with the current experience of humiliation and the fantasy that “all refugees are generally in the status of being humiliated” and that it seems as if everything depends on an external factor. Thus, the fixation on trauma gradually loosened. They expressed satisfaction that they did not have to talk about such things in front of their own people and openly expressed their attachment to the group and emphasized the “value of gathering”. Many showed signs of apparent improvement in psychological distress.

B.Z. is one of the most profitable members of the group. At the beginning of the therapy, he was extremely depressed. Later, he talks about his ambivalence about warfare in general and the killing “that you are forced to do in war”, about what is conventional and justified and what is not, etc. He mentioned several times that he had injured the index finger of his right hand on a machine. It was seen that his finger had been amputated. At one of the sessions, he started talking about that injury again, at first glance quite casually. He gave the impression that we would not hear anything new about it. But this time he told the whole story.

While he lived in Croatia, at the very beginning of the war, he was in danger, like many others, of being mobilized. Wanting to avoid mobilization, he broke that finger himself and contacted the doctor, who released him from mobilization. Later, when the worst of the war was over for him and he escaped to Serbia, doing something ordinary on a woodworking machine, he “accidentally” literally cut off that same finger. Then I told him: “B., that’s the finger with which you pull the trigger, with which you kill.”

Reintegration

Everything that is said to an individual in a group is heard by the whole group. By shedding light on the unconscious destruction of the “murderer’s finger”, the following sessions showed content that also related to positive events during the war and captivity. Pessimistic topics have now gradually given way to more positive ones. They talked about everything good that happened in the camp, one by one they continued with their associations. They described events when enemy soldiers helped them, when they occasionally protected them from exhausting work if someone was sick or injured. Some of the guards would deliver letters from their wives to them, or take it upon themselves to deliver one of their messages to their families. They secretly delivered food to them, sometimes helped to change their wet clothes or the blanket they were sleeping on, etc.

It happened that one of the soldiers recognized a former friend or acquaintance among the prisoners and protected him from beatings. Suddenly many such examples appeared. This was also noticeable in their daily functioning – taking care of themselves, health and family was more and more adequate, they put more effort into the obstacles in order to get adequate medical help, their claims for compensation after surviving torture “revived” again, more informed and educated. Speaking about this phenomenon in war veterans, Parsons (1988b, p. 295) said that it is about “achieving cognitive and emotional independence and strengthening the sense of self”. That is, trauma is integrated into personal life history.  Finally, without a twinge of conscience, they verbalized that “it’s good that they survived the war.”

Termination

The end of the group’s work was announced four months earlier. At first they accepted and commented on it as something “normal”, but soon they started asking me to “extend everything a little longer.” I used all these needs as material for working out the termination of the therapy. For these people, it was extremely important, that after more than ten years of exile, they could complete something and bring it to an end, and no longer remain trapped by the past. The end of the therapy was now a platform from which one could move on, precisely because it was at the same time a platform from which one could look back and be in touch with the fact that something has passed and that it is not the same as before.

Migrants, non-Balkan population

Most of the migrants we come into contact with are victims of torture, and/or their families have been exposed to torture. They come mainly from Afghanistan, Iran, Syria and Iraq. Most of the time, their movement is reduced to crossing from, for example, Afghanistan to Iran, then Turkey, Greece, Macedonia and finally to Serbia. According to data, only in the first year of migration, around 44,000 Iranians passed through Serbia. They were mistreated by military and paramilitary forces in their countries, sexually abused, experienced extreme violence by smugglers who brought them across borders, then by police and prison staff at the borders, but also by civilians in the countries through which they were in transit. All this left serious mental and health consequences for them. Their status is further complicated because the final destination they are aiming for is not Serbia, where they are “stuck” due to the visa-free regime.

Even those who would have stayed in Serbia are under great suffering – due to the slow procedures of obtaining asylum, while during that time they live in difficult conditions of shelters. The experience that they have no control over their lives and are already traumatized, deepens their mental problems and hinders their integration. They resort to various risky behaviors, drug and alcohol abuse, self-harm, crime.

Some of the types of torture

The most common forms of torture, registered by the IAN Center for the Rehabilitation of Torture Victims, are: kidnapping, blackmail, fraud for large sums of money when promising to be transferred to Europe, slapping, kicking, beating with batons and canes, intimidation of dogs, which it often ends with dog bites – even children. They were threatened with death and mutilation – personally or family members. Their teeth were knocked out, their nails were beaten, they were denied food and sleep, they experienced mock executions, their privacy and personal hygiene were denied, they were treated with electric shocks, suffocation, etc.

One of the special types of abuse is represented during their attempts to illegally cross the border from our area. They popularly called illegal crossings among themselves “game.” Because “game” is also luck if someone succeeds in crossing. Torture measures by the border police are implemented in the so-called “push back.” All means of violence are used in order not to discourage migrants from trying to cross the border again. And they tried several times a week, although they always came back beaten.

Help the helpers

With a short digression, I will mention just a few more examples of what drives these people to seek refuge. First of all, all the war events, forced mobilizations, mutilations, for example, by bombs leftovers after the Iraq-Iran war, blood feuds between their families, which are almost a daily part of their lives.

Those who are the first to hear the descriptions of the traumas experienced are helpers from non-governmental organizations that accept migrants immediately after their arrival. In Belgrade, it is the so-called Miksaliste. They work in cooperation with our state institution – the Commissariat for Refugees and try to take basic care of them. The first to be “hit” are translators and those who call themselves “cultural mediators”, building a bridge between the two often extremely different cultures of the Middle East and Europe. Next are us therapists, who often see our translator turn pale during the conversation, grab his head and say – doctor, I can’t do it anymore. It is intriguing that the translators of migrant – patient, translate the sentences in the first person and somehow enter the role of the traumatized from which it is difficult to “get out.”

This is also an introduction to the presentation of one such non-governmental organization of translators and cultural mediators, which asked IAN for help for its staff. I will never forget our first meeting with their managers who were literally shaking, conveying all the anxiety picked up from their organization and fearing whether we would agree to help them. Our initial idea was to provide supervision for translators. We were aware that we didn’t know exactly what was waiting for us. The group simply slipped over time into more and more serious work, grew practically into an applied one, with a lot of sensibility for the personal advancement of the members.

Many of the translators themselves came from the countries where the migrants came from. They learned the Serbian language, integrated and work mostly in the non-governmental sector. We dealt with various topics: the feeling of helplessness that they have as helpers, the imposed omnipotence that clients “push” into them (aspiration towards absolute categories – Tom Main) and the vicious circle of helplessness-power. We dealt with moral dilemmas that they often get into as helpers – what is morally and legally what they should do, what is not, and how it conflicts with ethics and good practice.

Sometimes something that seems very moral, is not moral, not even legal. For example, clients often ask them for money, then to withdraw and send money from their countries. It is illegal for them to help them in this, because it requires an identity card – which the migrant does not have. Taking money on behalf of migrants is an unsafe act, they can simply be accused of taking other people’s money. Some of the migrants are asking for help in finding contacts to move to Croatia. It’s illegal, but for them it’s a move that can reunite them with family members they’ve been separated from for years.

The members of the group themselves are very introspective, curious about psychological processes and solutions that would help them as much as possible in their dilemmas and free them from anxiety. They share content mostly related to work, but often also personal, intimate. They keep their boundaries easily, they understand that something should be discussed in individual conversations with the presenters, they are interested in dreams, they bring them up cautiously and ask questions so that they can deepen their work on themselves. Very quickly, the meetings began to differ greatly from the initial ones, when they denied the problems. They said that they “adapted”, that they did not easily endure the work emotionally before “and now it is routine.” Later, it turned out that they are tired, that they have little time for their private life, that they think about problems at work all day long, and spend less and less time on recreation and social life. Their responsibility is great, they communicate with many other services, the police, they take care of finding accommodation for users, they provide health care. Many have already announced after a few meetings that they have less problems with ambivalence and guilty conscience.

Contact with feelings

At one of the groups, after a short break, N. appeared, who wanted to discuss a recent incident. One of our citizens entered his office and asked him to call Interpol, it turned out that he was paranoid and had a knife with him. At first, says N., he found it funny, but soon he was exposed to the stranger’s verbal aggression. He somehow called a colleague using a walkie-talkie, and the incident was prevented from escalating.

Vignette

Supervisor: Have you considered whether you would respond if you had to defend yourself physically?

N: Yes, I thought that it is not the same when you react privately when you are in danger and when you are at work.

Supervisor: It seems to me that it’s normal to think of defending yourself when you feel threatened, and I understand that the job carries a responsibility that makes you wonder if you should defend yourself.

N: Yes, but it’s good that I managed to find a walkie-talkie and call security. And it’s lucky that there was a man on shift at that time who does the job professionally, otherwise someone else wouldn’t have answered when I called him.

Supervisor: We somehow haven’t dealt with this issue, the issue of safety, even though it is somehow always present because you work where you work, what are the experiences of others?

H., who was in front of the office at the time of the incident, joins in and continues: Yes, that security is not professional security, there are two older men taking turns, one of them has nothing to do with that job. Good thing he was there and actually did the job.

Supervisor: They let him go, no one called the police or an ambulance?

N: No. Later I found out that this man had come before, that he once had a screwdriver with him.

Others join in and A. says: Users sometimes fight in Miksalište.

1. and N: About once a month.

Supervisor: It seems to us that once a month is often.

N: Once a group of Afghans was stolen by Algerians, I guess, they stole their telephones and money, I called the police, it happened, for example, at three o’clock at night. After several calls, the police only delayed their arrival, 12 hours had already passed. Then the machetes flashed, (and he laughs… And the others laugh, men, while the female part of the group remains speechless – and pale…). They went and found those guys themselves. They return to Miksaliste, they take an Algerian, they hold a machete under his neck, the police came and I don’t know who called them, I guess one of the citizens saw what was happening on the street.

Supervisor: Are there any checks on who enters Miksalište?

N: Not anyone can enter.

B: Those fights are everywhere in every camp, they often fight each other.

Supervisor: He explained that the man was probably paranoid, sick, and shared his own experiences with paranoid patients in his practice, which were safely challenging, occurring in home visits…

The group listens attentively, New member V. seems very upset…

The supervisor asks N: How do you feel now? How do you think about it?

N: Well, now I’m ready, I always know where my walkie-talkie is, I always take the walkie-talkie to security before my shift, because it gets charged during the night and sometimes they don’t take it until we take it to them.

Supervisor: Are you somehow taking all the safety measures now to be better prepared for situations like this?

N: Yes.

A: We know what to expect from migrants, we have learned, we know what they ask of us somehow.

N: Yes, I already have all the answers and I know what they can ask us.

Supervisor: This was extraordinary after all?

N.: Yes, this doesn’t happen very often…

Supervisor: How do the new members feel when they hear these stories?

V: I worked one day in the camp, it’s a disaster there, I wouldn’t want to go again… There is a guy who is sick, the psychologists there say that he probably copes with his anxiety in a primitive way, he hits himself, beats his hands, four people were holding him. I really thought that I don’t have the strength to translate for a psychologist… Then some doctors examined him and said that now we should call the emergency services and the police to take him for treatment. Then someone from the commissariat came and was really unpleasant to the doctor that they called the emergency… Earlier they also called the hodja… his friends asked them to call the hodja, to exorcise the devil from him…

1. interjects: Imagine they treat him by having the hodja come… Unbelievable!

B.: I believe, one of our colleagues told me how one of his cousins ​​was healed by a hodja reading those mantras and after several meetings she got better.

We continued to talk about the importance of believing in something, that’s how the hodja entered the treatment.

That’s probably why I said at the end that the alliance between the therapist and the patient is very important (I thought to myself – we included these people who are on supervision – in the treatment, like a hodja).

Overlapping traumas – who is the helper and who is threatened?

Dreams were shared at the following meetings. About the traumas of the group members, the bombings they experienced and the horrors of war. They dreamed of buildings, swimming pools and roofs collapsing. They talked about the insomnia they suffer from for a long time, that banal sounds from the environment bother them and that they are often irritable. When we asked them how they used to fall asleep when they were little, they laughed and answered – with bombs. “Later it was impossible to fall asleep in silence, without explosions.”

Associations with various movies appeared. For example, when the son comes home and after the fall of communism says – from today there is no more God. Then they fell into thinking about parenting, what kind of parents they would be and that they have the need to criticize and correct parents who do not take care of children who are restless and noisy – and at the same time cause insomnia to the environment. They sifted through the dilemmas of how much they help and how much they are in trouble.

Furthermore, the question of their vulnerability, negative emotions and anger towards migrants was considered. They shared different cases when migrants lie to them, manipulate them, when they usurp their time, “and maybe someone else needs help more.” We dealt with their guilt reactions, how they feel when they know they’ve been manipulated, etc. At the end of one of the groups, topics were opened, how difficult it is for them because of what they do, that they can no longer have “small talks” with their friends, and that they no longer have patience. They question the meaning of life. Although individuals are rarely at group meetings, the process takes its course, “it swims.” They open up more and more and talk about their personal lives. More and more often they ask for individual conversations, under the pressure of the provocativeness of the process and the anxiety it brings.

Further Thoughts

We concluded that this group created its working atmosphere with its personal capacities. The difficult content that was heard did not affect the fact that we continue to work with them easely. They could bear the weight of their work and this allowed them to stick to it with great dedication despite the toxicity affecting them. They provide help authentically and with high empathy. From the initial idea of ​​supervision, their introspectiveness led to deeper personal growth. The process is dynamic, alive, motivating both for them and for us as co-leaders. Starting from “banal interventions”, to analytical work, expressing dreams, awareness of boundaries, the need for individual and deeper work – all this did not block us and made us afraid that we would be led into the elements and confusion.

The challenge of modification is constantly in front of us – an inexhaustible source of development and progress.

References

American Psychological Association (2018) Trauma. Available from: http://www.apa.org/topics/trauma/ (Accessed 10 October 2019).

Blackwell D (2018) Cultural transition, negation and the social Unconscious. Group Analysis 51(3): 304–314

Bovin, M.J., Marx, B.P., Weathers, F.W., Gallagher, M.W., Rodriguez, P., Schnurr, P.P. & Keane, T.M. (2016). Psychometric properties of the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders – fifth edition (PCL-5) in veterans. Psychological Assessment, 28, 1379–1391

Buchele, B. & Spitz, H (Eds.) (2000). Group interventions for psychological treatment of trauma.  New York: American Group Psychotherapy Association

Burlingame, G., Strauss, B. & Joyce, A. (2013).  Change mechanisms and effectiveness of small group treatments.  In M.J. Lambert (Ed.), Bergin & Garfield’s Handbook of psychotherapy and behavior change (6th Ed.). New York:  Wiley.

Dalal F (1998) Taking the Group Seriously: Towards a Post-Foulkesian Group Analytic Theory. London: Jessica Kingsley.

Dalal F (2003) The Social Unconscious: A Post-Foulkesian perspective. Group Analysis 34(4): 539–55.

Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 301-313.

Foulkes SH (1948) Introduction to Group Analytic Psychotherapy. London: Karnac.

Foulkes SH, Anthony EJ (1965) Group Analysis, Psychoanalysis and Sociology. Brunner- Routledge Group Psychotherapy. Second edition. London: Franklin

Foy, D.W., Eriksson, C. B., & Trice, G. A.  (2001). Introduction to group interventions for trauma survivors. Group Dynamics: Theory, Research, and Practice, 5, 246-251. DOI:  http://dx.doi.org/10.1037/1089-2699.5.4.246

Freud S (1926) Psychoanalysis. Standard edition 20, 259–270. London: Hogarth Press

Frosh S (2013) Psychoanalysis, colonialism, racism. Journal of Theoretical and Philosophical Psychology 33(3): 141–154.

Hopper E (2003) The Social Unconscious: Selected Papers. London: Jessica Kingsley Publishers.

Hopper E, Weinberg H (eds) (2011) The Social Unconscious in Persons, Groups, and Societies. Volume 1: Mainly Theory. London: Karnac.

Howard R, Berry K, Haddock G: Therapeutic alliance in psychological therapy for posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Psychother 29(2):373-399, 2022. doi: 10.1002/cpp.2642

Lange, J.T., Lange, C.L. & Cabaltica, R.B.G. (2000). Primary care treatment of post-traumatic stress disorder. American Family Physician, 62, 1035–1040.

Lanius, R.A., Frewen, P.A. & Brand, B.L. (2016). Dissociative aspects of post- traumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis. Available: uptodate.com

Najavits, L.M. (2007). Psychosocial treatments for posttraumatic stress disorder. In P.E. Nathan & J.M. Gorman (Eds.), A Guide to Treatments That Work (3rd ed.; pp. 513–529). New York, NY: Oxford University Press.

Nazarov, A., Jetly, R., McNeely, H., Kiang, M., Lanius, R. & McKinnon, M.C. (2015). Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatrica Scandinavica, 132, 4–19.

Nitzgen D (2002) From Context to Content: Retrieving the Social in Group Analytic Practice. Group Analysis 35(3): 411–423

Nicholl, C. & Thompson, A. (2004). The psychological treatment of post- traumatic stress disorder (PTSD) in adult refugees: A review of the current state of psychological therapies. Journal of Mental Health 13, 351–362

Parsons, R. J. (1988). Empowerment for role alternatives for low income minority girls: A group work approach. Social Work with Groups, 11(4), 27–45. https://doi.org/10.1300/J009v11n04_05

Ritter M. (2014) Silence as the Voice of Trauma. The American Journal of Psychoanalysis 74 (2): 176–194.

Seligman  ME The effectiveness of psychotherapy: the Consumer Reports study.  Am Psychol. 1995;50965- 974

Shatan, C. F. (1973). The grief of soldiers: Vietnam combat veterans’ self-help movement. American Journal of Orthopsychiatry, 43(4), 640–653. https://doi.org/10.1111/j.1939-0025.1973.tb00834.x

Van der Kolk, B. A. (1987). Psychological Trauma. American Psychiatric Press, Inc., Washington, DC,

Volkan VD (2001) Transgenerational transmissions and chosen traumas: An aspect of large-group identity. Group Analysis 34(1): 79–97

Yalom  I.D.(1985).  The Theory and Practice of Group Psychotherapy. 3rd New York, NY Basic Books Inc Publishers

Psychiatrist and group analyst working in private practice in Belgrade

smilojevic18@gmail.com