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Trauma Therapists in Israel
A Qualitative Study into Personal,
Familial and Societal Sources of
A Priori Countertransference
Trauma Therapists in Israel:
A Qualitative Study into Personal, Familial and
Societal Sources of A Priori Countertransference
Copyright © 2008, Yvonne Tauber
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Trauma Therapists in Israel:
A Qualitative Study into Personal, Familial and Societal Sources of A Priori Countertransference
Traumatherapeuten in Israël:
Een kwalitatieve studie naar persoonlijke, familie-, en maatschappelijke achtergronden die van invloed zijn op a priori tegenoverdracht (met een samenvatting in het Nederlands)
It is a privilege to have so many people to thank for the many different ways in which they have supported me along the path towards the final version of this dissertation. My promotores have all, in their unique ways, encouraged, criticized, stimulated and supported me. I am grateful to Harry Kunneman for his generosity of spirit in guiding me through the last and crucial phase, for his breadth of interest and knowledge, enthusiasm and sensitive support. I want to thank Christien Brinkgreve for her genuine interest, both professionally and personally, for her critical thinking, her open-mindedness, the loan of her wonderful hide-away in the dunes for some quiet writing, and especially, for her unwavering commitment to protect the academic expression of my true voice and professional convictions. My thanks to Onno van der Hart for his immediate and positive response to my ideas for this dissertation, his encouragement of the organic development of the sequence of the studies, for nurturing the work during the earlier stages and for the flow of articles and books he made available to me at just the right times. To Danny Brom I owe particular thanks for first suggesting I develop my ideas into a doctoral dissertation and contact Onno van der Hart, and for our stimulating and at times, quite heated, discussions that helped me articulate my ideas more sharply.
I also want to thank Onno and Christien for their unfailing, heartfelt concern for both Danny's and my physical and emotional wellbeing at times when life in Israel was at its most precarious.
There are many more people for me to thank, but first and foremost I want to express my immense gratitude and appreciation for the therapists who allowed me to interview them and learn from them. Their openness, integrity, commitment to their clients, courage and wisdom, have remained a source of inspiration. Not all are still with us. You are sorely missed.
I also remain indebted to Haim Dasberg, Karen Shachar and Eli Witztum for sharing their personal experiences regarding the development of awareness, in Israel, of their respective fields of expertise, Holocaust, sexual and combat trauma;
to Yolanda Gampel without whose generous investment of time and support during the writing of In the other Chair, I might not have started this dissertation; to Yitzhak Mendelsohn for sharing so much of his knowledge of interpersonal traumatization and reconciliation; to Babette Rothchild for her reading of the manuscript and helpful comments; to Kathy Steele for reading sections of the manuscript, her encouragement and interest; to Sheri Oz for her support throughout the process of this doctorate, and for proofreading much of the manuscript; to Elisheva van der Hal and Yitzhak Mendelsohn for their reading and rereading of the different versions of the manuscript and valuable comments; to
xii AcknowledgementsEva Elbaum and Elisheva van der Hal for their help with the Dutch summary; to Avraham van der Hal for taking on the onerous task of preparing the final manuscript for printing, and demonstrating such gracious patience with me along the way; and to Shlomo Avayou, for teaching me about some of the historical developments leading up to the formation of Sephardic and Ashkenazy Jewry. I also want to thank Haim Elbaz, MD and Ronald Ban, MD for teaching me important lessons about healing relationships, co-operation, empathy and respect.
Conversations with colleagues and friends on topics related to this dissertation have been of great help. And on a personal note, I thank my dear friends for enabling me to withdraw for sometimes long bouts of writing while leaving me confident in the knowledge that they would be there at any time to share conversations, meals, concerts and films.
Because of the subject matter and research methods I have chosen, I have had to deal with highly emotive, at times traumatic, material. I therefore want to particularly acknowledge Eva Eshkol, Yitzhak Mendelsohn, Marcia Shaharabani and Elisheva van der Hal who held me in a solid embrace of warmth, friendship, humor and caring. They have, each in their own way, been true companions in all the ups and downs of this work.
I can only hope that all my friends, colleagues and relatives, in Israel and abroad, who invariably expressed interest in how I was getting along and how the work was progressing, know how meaningful their support has been.
Introduction14 Chapter 1. IntroductionChapter 1. Introduction 15
The encounter between a person seeking relief from psychological pain and difficulties and the trained professional to whom he or she turns to for help is rich in semi-conscious or unconscious emotions as well as preconceived ideas and values held by both parties in the dyad. It would be reasonable to assume that these emotions and thoughts impact upon the therapeutic process and hence need to be brought into awareness, understood and monitored. Whereas the professional literature is, of course, replete with explorations of the inner world of the client, that of the therapist has not received nearly as much attention but might nonetheless significantly impact the therapeutic process.
In this dissertation, it is the individual therapist's personal contribution to the dyad, specifically with traumatized clients, rather than the theoretical approach and technical interventions, that is of interest; the extra-professional luggage as it were that the therapist brings along to the sessions. The term I have coined for this phenomenon is a priori countertransference (Tauber, 1998), as these thoughts and feelings are not evoked by way of direct interactions with the client, but arise even before the actual encounter with the potential client.
It took some steps in my professional development before I was able to conceptualize a priori countertransference. During my graduate studies in the early eighties in San Francisco, almost every professor would start a new course with a quick check of hands to see who was currently in therapy, and then encourage those who were not, to start as soon as possible. The message seemed to be that the study of clinical psychology demanded more than intellectual effort. I had come to the U.S. to go to graduate school but once there, I had strong emotional reactions to being in the country that, had its borders been open to Jews just before, and during the Second World War, might have saved the lives of my relatives and of many others. At the same time, I was acutely and gratefully aware that had it not been for the American and other allied soldiers, my parents would not have been liberated in time and I would not have been born.
Therefore, I looked for a therapist who had some professional and perhaps, personal, understanding of Holocaust survivors and their offspring. The first two therapists with whom I met were highly recommended, but I sensed a tendency to over-identification and too much, what I have called, anticipatory empathy, which warned me off both of them after the first session. The third therapist told me she herself was a child of survivors without going into further details, and seemed appropriately interested. The therapy was excellent, but rudely interrupted when a letter, informing me that my mother was terminally ill, summoned me home to Israel.
At that time, I had no theory yet about the impact of the person of the therapist on the course of therapy, just intuition and personal experiences ranging from good to dreadful. A visiting psychiatrist at the counseling service at the
16 Chapter 1. IntroductionHebrew University in Jerusalem stands out positively in my memory. I saw him for psychotherapy when I was a young student in distress after terminating my engagement to be married. He determined the length of each session as he deemed appropriate at the time, ranging anywhere from a few minutes to well over an hour, always remaining respectful, supportive and professional. Within the few months that he was there, he firmly steered me back towards recovery and growth. An example of a dreadful experience was in London in the mid-seventies, with an exjunkie, ex-drug dealer who, without formal training, led encounter groups.
A theory about the impact of the person of the therapist started to take shape for me in 1987, in Jerusalem, when I joined an organization that was just being set up to provide psycho-social aid to Holocaust survivors and their offspring. We had no clients yet when I noticed I had significant somatic, cognitive and emotional responses. I first wondered whether those were still aftershocks from some of the recent changes in my life, but when I checked with colleagues, they too became aware of reactions they thought were connected to the work we were about to start. That was when I thought of the concept of "a priori countertransference." Together with a small group of colleagues I set out on a journey of self-exploration in order to learn what in our backgrounds of being Holocaust survivors and children of survivors might trigger such responses and what these might have to teach us (Tauber, 1998). One of the more shocking discoveries was that, without exception, we had all gone through at least one course of otherwise adequate psychotherapy, without, in any way, addressing the Holocaust and its consequences on our lives.
Over the following ten, fifteen years, my clinical practice expanded to include survivors of other interpersonal traumatic events, such as terrorist attacks and sexual assault. It was not rare to find myself in the position of being the "first one" clients told of their sexual abuse experiences. Most striking was to hear this from a child survivor who had been in therapy for years with several well known therapists who had specialized in working with Holocaust survivors. She had never been asked directly, however, or felt empowered to speak of the intense betrayal she experienced when she was sexually abused as a small child after the Holocaust.
Fluctuations in Awareness of Trauma
Extensive reading in the literature opened my eyes to societal--and professional--blindness to traumatic events and their consequences, followed by periods of awareness, which in turn were followed by oblivion and blindness again.
The first major theoretician of the impact of traumatic events was Freud's contemporary Janet, but despite his "large body of work and his profound
Chapter 1. Introduction 17influence both on his contemporaries and on the next generation of psychiatrists, his legacy was slowly forgotten" (Van der Kolk et al., 1996, p. 55). Freud initially accepted Janet's understanding of trauma and traumatic memory but came to mostly reject the reality of childhood sexual trauma in favor of a fantasized seduction (Van der Kolk & Van der Hart, 1991). This led psychoanalysis to disregard so many patients' horrendous experiences, including incest (Van der Kolk and Van der Hart, 1991). In the later part of the twentieth century, Janet's body of work was gradually reintroduced (e.g. Ellenberger, 1970; Van der Hart & Friedman, 1989; Van der Kolk & Van der Hart, 1989).
Awareness of trauma increased significantly during and just after the World Wars (Herman, 1992; Van der Kolk et al., 1996). The waning of awareness occurred in the more peaceful post-war years. This might have meant, for instance, that a veteran who turned for help for psychological complaints in the 1950's would not have been recognized as potentially suffering from traumatic war experiences. Studies in Israel have shown similar, rapid cycles and the increasing understanding of the impact of war traumas on society as a whole. (Bleich, 1992;
Solomon, 1995a; Witztum & Cohen, 1994; Witztum & Kotler, 2000; Witztum, Levy, & Solomon, 1996).
Holocaust survivors remained clinically invisible for decades (Tauber, 1998, 2003, Chapter 3), unless they were mentally ill and needed psychiatric intervention. In those cases, their Holocaust experiences might still not have been addressed. Such invisibility has also been true for sexual abuse survivors, even to this day.