Countertransference and empathy in a traumatizing context. Experiences in Guatemala
A version of this article was published in 2012: Rohr, E. Challenging Empathy. Clin Soc Work J 40, 450–456 (2012). https://doi.org/10.1007/s10615-011-0339-0
Introduction: scientific debates about trauma
Scientific debates and extensive investigations about trauma leave no doubt that trauma neither ends nor vanishes with the ending of the traumatic experience. Keilson (1979) was among the first ones to point out that trauma has to be understood as a continuing process. The therapies he provided to Jewish children in the Netherlands, who had survived the Shoah, clearly showed that trauma continued even after the atrocities had ended. It emerges and is reactivated in sequences. This means that trauma that stays unresolved “will remain an insistent present” (Varvin 2003, p. 209) and consequently can be transmitted unconsciously from parents to children in a transgenerational process (Gampel, 2006).
Increasing clinical investigations in the field of psychiatric traumatology (Varvin 2003, Becker 2006) have reconfirmed these findings, leading eventually to some alterations of the diagnostic formulation of Post-Traumatic Stress Disorder (PTSD). Even though the “establishment of the formula of PTSD has assisted in unifying previously disparate fields of inquiry in trauma research” (Silove 1999, p. 201), it soon became evident that “PTSD was a result of relatively clearly circumscribable traumatic events … and fails to capture many of the protean sequelae of prolonged, repeated trauma” (Herman 1992, p. 377).
Therefore, the validity of the application of the western concept of trauma to diverse cultures and societies, where political abuse and human rights violations prevail, has been questioned (Silove 1990).
In Latin America, psychologists like Becker (1992), who worked for many years with victims of torture in Chile and Martín-Baró (1990) from El Salvador, insist that it is impossible to understand trauma only in terms of the clinical diagnostic formulations of PTSD, because trauma is a social and political phenomenon and affects society as a whole.
Becker’s and Martín-Baró’s understanding of trauma amplifies Keilson’s sequential model of trauma, and stresses the importance of the social environment of a survivor concerning the future development of the traumatic process. They point out that there is no post-trauma.
Experts working in psychosocial fields after catastrophic events need to understand the effects of trauma, because they may not only be confronted with complex individual trauma, but also with traumatized populations.
Only with this knowledge are experts able to bear, to understand and to contain different expressions of trauma they may encounter. Under these circumstances, supervision and psychosocial support are not a “luxury” as Becker (2006, p.102) stated, but an essential health necessity. Otherwise, the risk of secondary trauma will increase, eventually traumatizing experts themselves (Figley 1995). However, the effort to support, to understand and to contain trauma can lead experts to exceed their boundaries, turning their work into an “agony of anxiety” as Ferenczi (1932/1988, p. 81) once called it, getting close to “feelings of death” as Becker (2006:64) added.
The following case study of a group analytic orientated supervision workshop in Guatemala aims to explore what kind of supervisory capacities are needed to bear, contain and to understand traumatic situations. The workshop was part of a peace and reconciliation project of the German government, aiming to improve community mental health services and qualify social workers and psychologists to offer professional counselling services to groups and institutions, who were involved with victims of the war. This article will, therefore, first describe the political and social situation of the country and then discuss the theory of empathy and countertransference continuing with the description of an extraordinary supervisory case example that could be considered as a journey into the “agony of anxiety”. Finally the article concludes with reflections and recommendations for psychosocial work in post-conflict societies.
The social and political background
Since 2000, the German government has established a peace and reconciliation program in Guatemala to support the fragile peace building process in the country (Duque 2007). After 36 years of war, the results of the so-called “armed conflict” were devastating. But what was even worse was that the violence continued after the end of the war. Lynching increased throughout the country, and violence against and homicides of women reached one of the highest levels in Latin America (Amnesty International 2020, Sanford 2008). Only a few human rights violators were prosecuted. The report of the “Secretaría de la Paz” (2009) warned of “epidemic violence” threatening the stability of Guatemalan society and two truth commissions had come to the conclusion that the majority of the indigenous Guatemalan population had been traumatized and that the “social fabric” of society had been severely damaged and partially destroyed (REMHI 1998, CEH 1999). Even though the war had ended nine years before the training of group analytic supervision began, the effects of the endemic violence were omnipresent.
Although efforts were made to minimize security risks in the workshop, individual participants faced violence almost daily. Just a few years ago, a 72-year-old catholic nun, who had participated in one of our first workshops, was murdered not far from the villa where the workshop took place. It seemed as if violence could not be avoided; it dominated daily life and all working routines.
This was the political and social context for the group analytic supervision training.
Evaluations had shown that many psychologists were engaged in organizing mass graves exhumations in indigenous villages or working with extremely traumatized indigenous widows within community mental health projects. These professionals were left alone with the extreme suffering of the people they worked with. As at the time, no supervision in the sense of counselling professionals existed in the country, the organisers of the group analytic supervision decided to offer workshops aiming at strengthening the professional capacities of the psychosocial experts.
Without any doubt, there are different ways to approach this challenge. One way is to concentrate on supervisory methods and tools; another is to “teach” empathy in a traumatizing context. The concept of empathy might be considered one of the core concepts of psychoanalytic thinking and at the same time an essential part of countertransference reactions. But how do empathy and countertransference function in a context that has been imbued with trauma?
Psychoanalytic understanding of empathy
Looking into psychoanalytic literature, one finds that there has been a considerable amount of writing about empathy, starting with Freud, who acknowledged being somewhat ambivalent about this topic, because of the “mystic character” of empathy, according to the letter, he once wrote to Ferenczi (Grubrich-Simitis 1986).
According to Kakar (2008, p. 14) the actual definition of empathy given in the Oxford English Dictionary, confirms this “mystic character”, explaining that empathy is considered to be the power to project one’s own personality into the object and by doing so, to completely understand the other. Kakar, an Indian psychoanalyst, points out that psychoanalysts seem to avoid the scientific challenge, which is connected with empathy. He is convinced that this has to do with the very nature of empathy, because empathy seems to function much more like a meditative practice than a psychoanalytic and scientifically proven technique. Freud seemed to be aware of this meditative nature of empathy, when he wrote: “Experience soon showed that the attitude which the physician could most advantageously adopt to realize the analysis, was to surrender himself to his own unconscious mental activity, in a state of evenly suspended attention to avoid as far as possible reflection and the construction of conscious expectations, not to try to fix anything that he heard particularly in his memory, and by these means catch the drift of the patient’s unconscious with his own unconscious” (Freud, 1923 p. 239). Freud suggests, in this well-known advice to psychotherapists, to liberate themselves from all conscious thoughts and emotions in order to be able to receive messages from the unconscious of the patient. That is an extraordinary task, not easy to accomplish at times, but necessary in order to disclose the messages of the unconscious.
Referring to this specific psychotherapeutic attitude and psychoanalytic technique, Ogden speaks about “day-dreaming experiences” (1997, p.719), meaning the capacity to allow oneself to inconspicuous thoughts, feelings, fantasies, day-dreams and body perception in the course of a psychotherapeutic process. Ogden described with his “day-dreaming” concept exactly what Freud meant, when speaking about floating attentiveness and named the sources that might produce the associations that are so valuable for the understanding of the psychoanalytic process.
Taking into account the works of Freud and Ogden, Kakar shows that this capacity of “day-dreaming” is quite similar to the transcendental capacities of some of the famous Gurus in India. According to Kakar (2008, p.117) many psychoanalysts today try to minimize the transcendental character of empathy, saying that the identification of the therapist with the patient is temporary and not regressive and under the self-control of the therapist, and it contains neutral and even cognitive elements. There is obviously a lot of fear that empathy could only be a projection of the psychotherapist’s feelings and of countertransference, an empathetic fantasy. According to Kakar (2008, p. 118) these vague definitions of empathy in combination with these objections and potential risks are responsible for the ambivalence found in the majority of scientific publications about empathy.
Nevertheless, there are quite a number of psychoanalysts, who have different opinions about the topic. One of them is Bion (1967), who described the ideal psychotherapist as someone who could give up, for the sake of the psychotherapeutic situation, memory and desire, and even understanding. He reiterates that psychotherapists should block off the noise of the material world and all sensuous perception in order to be able to receive the messages from the psychic world. This capacity to hear the unconscious messages leads to an extension of pre-conscious channels of communication and a greater capacity to recover messages from the depth of the psychic world. And Kakar (2008, p.124) adds that empathy will grow only when the functions of the self can be given up with greater ease and when the fear of drowning can be handled less defensively. Then the potential of the psychotherapist to daydream can be strengthened and empathy can be amplified.
It is astonishing in a way that Kakar does not connect empathy and countertransference reactions, because it seems obvious that countertransference does not work without empathy and that empathy is a crucial part of all transference processes.
Therefore, it might be helpful to draw the attention to a real case, experienced in a group analytic supervision workshop in Guatemala, where a lot of empathy embedded in strong countertransference reactions was needed to understand what was talked about.
Pedro’s case
Pedro, the only man in a group of women, volunteered in the beginning of a group analytic supervision workshop, to present a case that was still disturbing him. I knew Pedro from a previous workshop and was happy to see him again. He had been very critical at that time, since he was not familiar with group analysis or with psychoanalytic ways of thinking. Now, his return might mean that something in the workshop had been convincing after all. I felt relief having been able to reach him, because he was well known in Guatemala, having published books about one of the many massacres that had taken place during the war in a remote indigenous community. I remember thinking that if I managed to reach him, maybe it would be possible to reach other people in this workshop as well. The workshop participants also seemed to be grateful that he volunteered to present a case and encouraged him to start.
Pedro talked about the story of his travels to a distant indigenous village, way in the north of the country, to organize an exhumation process of a mass grave. Although it was a five hour journey, he had travelled there many times, because it turned out to be a rather complicated process that arose after the exhumation had taken place?
An indigenous family, who had lost the father during the war and suspected him to be one of the bodies in this mass grave, had fought for years to get the official authorization for an exhumation of the grave. Finally, the authorities granted the authorization and the forensic anthropologists started with the exhumation and found in the mass grave not only the body of the father, but the body of an uncle and many others from the village.
The uncle’s family did not live anymore in the village, since they had fled and lived as refugees in a camp in Mexico. Since Pedro was in charge of the exhumation, he decided to search for the uncle’s family to tell them about the exhumation and ask where to bury the dead man. After a lot of research, he managed to find the only living daughter and travelled to visit her in Mexico. She told him that she wanted her dead father to be buried in Mexico, close to where she now lived.
Returning with this message to the village in Guatemala, her cousins and her aunt rejected this idea, arguing that it was them, who had fought for the exhumation and that the body of the uncle should be buried in the village, where he had lived and died. Pedro kept on travelling back and forth to Mexico, but the positions on both sides of the family remained rigid and it seemed impossible to find a solution
Weeks passed and Pedro felt exhausted and hopeless. No matter what he tried, nothing seemed to work. Even worse was that the judge in the nearby city urged him to organize the burial, since it was illegal to leave dead bodies unburied for such a long time. If the families could not be reconciled, he threatened to order a burial of the dead man in another community mass grave. Pedro felt desperate and could not understand either of the two parties of the family and asked the supervision group for suggestions, what to do.
After a short silence, one of the women in the supervision group asked him, somehow reproachfully, why he was engaged in such an emotionally difficult and stressful job, adding that she thought this was too much to bear. She continued by saying that as a psychotherapist she had learned that it was necessary to protect oneself and not to trespass one’s boundaries. Pedro answered with a contemptuous smile, saying that he considered it his moral and political duty to be engaged in this type of work and he knew how to take care of himself.
In the course of the ensuing discussion, the woman kept on talking about fears and anxieties, thus pointing to defensive reactions in the group. Obviously, she felt a strong urge to protect the group like a good mother, feeling insecure, not knowing if I would be able to protect the group or if I would push the group too far and beyond its limits with this unknown instrument of supervision. However, underlying these anxieties, a conflict emerged, between Pedro and this woman. Pedro left no doubt about his political commitment and his strong left wing political beliefs, whereas the woman fit the stereotype of the upper class psychotherapist who stayed out of political conflicts. While she made sure to protect herself by not getting involved, she represented at the same time the position of the conservatives in the country. There was a lot of unspoken tension and aggression in the group. Shadows of the war had entered our supervisory space and the irreconcilable conflict was frightening everybody.
While listening attentively, I felt many thoughts and associations race through my mind, but my strongest fear was that I had not understood everything that Pedro had told us, and maybe not ever being able to understand the key issues behind the story. I was almost sure that this was a case that we would never be able to resolve. My own countertransference reactions, of not understanding, pointed to the danger connected to the material that Pedro had presented. I noticed that resistance, fears, anxieties and aggressions were dominating the group.
Then someone in the group asked Pedro about more details and he talked about his work, the exhumation and the difficult situation in the village. Again, I had the feeling of not being able to follow his words or to imagine this village. It felt like a blurred picture, as if a photographer had trembled when taking the picture and even though I tried very hard to get a clearer image, I did not succeed. Feeling irritated and profoundly disturbed, I felt like on a journey into nowhere. Even my ability to speak Spanish seemed to have vanished.
Finally, Pedro began to talk about the massacre. Even though the events he described were horrible, I began to understand. The father of the daughter, now living in exile in Mexico, had been denounced to the army as a supporter of the guerrilla. The army invaded the village, captured and ordered him and many others to be tortured in front of the whole village. The soldiers forced every man, woman and child to watch. Some time later, the guerrilla arrived, entered the village and killed those who had denounced the tortured men. When the army and the guerrilla finished their killings, dead bodies lined the streets leading out of the village.
There was silence and a strong feeling of pain and agony in the group. Then someone said with a breaking voice, how shocking this was to hear and to imagine these atrocities. Like all others in the group, I could see dead bodies lying on the dusty streets of the village. It was an almost unbearable image. My strongest instinct at that moment was to flee, just to get out and get away.
Then I suddenly became aware of my reaction and thought, well, that is exactly what this girl’s family did, flee and go to Mexico. Then I thought about this girl, I could see her now very clearly, as a young indigenous girl standing in the crowd of the villagers, dressed in her brightly coloured indigenous clothing, forced to watch her father being tortured, hearing him crying and seeing him die. I could imagine, partially I guess, what she must have felt at that moment: agony, immense pain and suffering, but also shame, feeling so utterly helpless, loneliness in the midst of a crowd of people, all of them paralysed in utmost fear and terror. Nobody dared to do anything to help her father, not her mother, not her relatives, nor her neighbours.
Even though these images were almost unbearably painful, they helped me to think again and regain my capacity to conduct the supervisory process, now with more energy. Finally, I began to understand why the daughter insisted on having her dead father buried in the place where she now lived. She simply wanted to have his dead body close to her now as a late compensation and reparation for having left him alone in his agony. At least she wanted to offer him a burial in dignity and according to Mayan Indian religious rituals, to save his soul and to reconcile with her own feelings of shame and guilt.
I shared these thoughts with the group. Immediately the tension left Pedro’s face. The group relaxed and some of the participants leaned back in their chairs. Now they could understand the young woman’s desire to have her dead father buried close to her. That was her only possibility to find some peace with the past and to maybe soothe her trauma. But what about her cousins and her aunt back in the village in Guatemala? Their situation became understandable as well: They had done everything to finally get the authorization for the exhumation. They felt resentful towards the girl’s family, who had fled after the massacre, while they stayed. Not allowing her to have the dead body of her father, seemed like a late punishment for having left the village and having left them as well – with the dead bodies lining the streets and the horrifying political conflict that separated the village. On one side, the supporters of the guerrilla and on the other side the supporters of the army. This was exactly the conflict that had been mirrored in the beginning of the supervisory process in our group.
Now we could see Pedro’s smile coming back. Now he would know how to talk to the daughter, to her aunt and her cousins. He felt sure that now he would be able to reach an agreement between the two families, because now he understood the trauma that both parts of the family had experienced and how they both had tried in different ways to deal with it. At the same time he realized that the trauma was still alive, having been reactived through the exhumation process. With great relief, Pedro closed the case and thanked the group. We all headed outside, very hungry and thirsty, happy to have our break with lots of coffee and sweets.
Reconstructing the process of understanding
Reconstructing this painful process of understanding on a theoretical level is not easy, because to be empathetic in this case meant to go on a journey into unknown lands, which turned out to be an “agony of anxiety” and a confrontation with trauma and death. The process of understanding started with free-floating attentiveness, as Freud (1923) mentioned and the material as well as the cognitive world vanished as Bion (1967) pointed out. My command of the Spanish language disappeared and a state of mind developed that could be compared with daydreaming experiences. Blurred images allowed no rational thought and intellectual and professional orientations, aims and directions simply disintegrated. The free-floating attention turned into something Kakar (2008) called “drowning”. All knowledge vanished, there was no desire anymore and no understanding. In contrast to Kakar’s analysis, there were however, at least temporarily, heavy regressive motions in this process of “drowning”. Feelings of emptiness, helplessness and of shame have to be recognized as indications of regression. These were not easy feelings to bear. However somehow, unconsciously, it was possible to persevere, instead of fighting them off. And by bearing the feeling of almost drowning, I was able to transcend boundaries, to find access to the unconscious and traumatizing material of the story and to finally identify with this girl, standing there in the middle of the crowd, watching her father suffer and die. The identification with this girl was the turning point in the process of understanding through countertransference reactions. This empathetic understanding of the trauma of this girl opened up the door to an emotionally based understanding of the whole situation.
This step from empathy to an emotionally based understanding cannot be described only in terms of transcending boundaries, because it would not take into account the conflictive process. Indeed, the story of Pedro shows how the core conflict was mirrored and experienced on five different levels throughout different stages of the case work:
• The initial scene in our supervisory workshop produced a clash of two radically opposed political positions within the group, thus opening up the stage for further conflict connected to the case.
• Conflicts shaped my countertransference reactions, when it was not possible anymore to relate or to connect to the group, neither hearing nor understanding Pedro’s words. There was a complete breakdown of communication, producing an enormous amount of anxiety.
• Finally there was this terrible conflict in the village, eventually uncovered during our case work. It turned out to be the central political and national conflict between the supporters of the army and the supporters of the guerrilla, ending up in mutual denunciations and the brutal killing of numerous indigenous men in the village.
• This past conflict found a continuation in the present conflict of the two families, not being able to agree upon the burial place of the dead father and uncle. Effects of the trauma that had been produced by war still were alive, not allowing wounds to heal.
• The conflict showed itself also in the unsuccessful working relationship Pedro had established with people in this village. Because of the unresolved trauma it was not possible to reconcile these two families and find a solution, where to bury the dead father and uncle.
In this case, trauma showed itself in the group as a basic and permanent state of conflict, producing symptoms and fears of “drowning” and finally a severe crisis. However, in this process, resistance as well as defence structures partially broke down, allowing increased flexibility and – most important – creativity to grow; that is, new ideas, new thoughts and new perspectives. Only through crisis and the painful loss of knowledge and power an emotional and empathetic understanding of the traumatizing situation became possible.
Lessons to be learned
In addition to understanding trauma, it is quite important for psychosocial experts working in traumatized societies, to realize that “trauma will not only persist as an insistent present memory of what happened, but will affect how the world is perceived, how relationships with others are experienced, and how the person relates to self and others” (Varvin 2003, p. 209). This, of course, is true also for working relationships, because traces of trauma might surface in any professional environment at any moment, as well as in counselling and supervision case work, where it might least be expected.
Psychosocial experts, working in post-conflict and often enough heavily traumatized societies, have to be well aware of this fact and have to be prepared to bear, to understand and to contain traumatic phenomena. This means foremost and fundamentally not to be afraid of conflicts, not to fight off own feelings of helplessness, of impotency and regression. Acknowledging one’s own vulnerabilities and limitations helps to relate to the needs of traumatized populations.
In this case, a clinical approach would not have been helpful, since it was Pedro’s task to organize the exhumation process and bring it to an end. To accomplish this task he had to deal with trauma, but he was not in any position, nor was this his task, to diagnose or to treat traumatized persons.
Moreover, and without any doubt, Pedro’s dilemma could only be solved with the help of a supervisory support group. Psychosocial support in a group of colleagues is health-saving and a possibility to contain the fear of drowning, thus helping a person to regain trust in its own professional and personal capacities and feel the solidarities of others. Feeling, experiencing and living the relatedness to others is decisive to bear and eventually to overcome fragmentations and polarisations, always connected with trauma.
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Dr. Elisabeth Rohr
Was professor of Intercultural Education at the University of Marburg / Germany until 2013. She is a sociologist and a graduate of the Goethe-University in Frankfurt with emphasis en social psychology and a group analyst since 1986. She has mainly worked in work related fields as a supervisor of teams, groups and individuals in leading positions. As of 2000 she has been engaged in the German government program of peace and reconciliation in Guatemala. Her scientific focus is centred upon studies about migration, religious fundamentalism, supervision and group analysis.
erohr@staff.uni-marburg.de