Later, through her written review of the session and the supervisor’s comments, I found out that there are some situations where it’s acceptable for therapists to cry in front of their clients. What a beautiful and truly confusing profession.

#therapy #ptsd #guilt

“Hello, my name is L, I am 19 years old, until February 24th I lived and worked in Mariupol, then returned to my family in Donetsk area, and for several months as we lived there, we experienced continuous bombings, there was no food, water or phone reception.” Speaking in a robotic, lifeless voice without a hint of emotion, she started recounting one horrific incident after another from her life in the war zone as if she was reciting items from a grocery list. At some point, I realized that the girl had not given me a moment to introduce myself, but I couldn’t gather the courage to interrupt her story. “I came here because most days, I struggle to sleep. It’s difficult to wake up and go out to buy food. In the past two or three days I haven’t slept at all. It’s not that I’m thinking about anything; I just can’t bring myself to sleep. And with all of this, I have to find a job here in Moscow.”

She later mentioned that for the past six months she could not get herself to cry. With the overlap of the war's events and her history of enduring severe family abuse, it became very clear that she was suffering from complex post-traumatic stress disorder (CPTSD). In order to protect the psyche from the never-ending nightmare of reality, grief and anger got completely dissociated from conscious mind, incidentally suppressing a range of other emotions and normal bodily functions. However, what I found difficult to comprehend was why she had chosen to come to Moscow. Given everything that had occurred in her hometown since 2014, why would she relocate here of all places?

She eventually revealed that she was considering evacuating to the territory controlled by Ukraine at first but changed her mind when her good friend from Moscow invited her to stay. Our session was just a few days after the mass military conscription began, but in Moscow it was still hardly evident. I couldn’t help but imagine how dreadful it must have been for her to arrive in this pretentious expensive city, where everyone seemed oblivious to the ongoing war, casually brunching in hipster restaurants, attending weekend wine festivals, and watching fireworks shows. “How do you find living in Moscow after all that you’ve been through?” I asked. “Oh, it’s okay, my friend is taking good care of me. At first, I thought I may have some trouble taking the metro with all the loud noises from the trains, but turns out it’s not an issue. But fireworks are still tough, they sound exactly like the type of projectiles that were used to bomb our street a few months ago, I get startled easily”.

It dawned on me that she didn't fully grasp the intention behind my question, so I rephrased it. “Is it difficult to see all of these people in the streets enjoying peaceful life when your hometown and your family is still in danger?” “No, it’s the opposite”, she replied without a trace of anger, “I don’t think I deserve to live here peacefully like everyone else does. I feel so guilty that this obligatory military conscription started for you guys here. It’s because of us that now you have to struggle here, too, you know.”

As I was about to conclude the session and began summarizing the topics we had discussed, I felt my eyes getting filled with tears that I could not control anymore. The therapist is not supposed to cry during the session, this is basic textbook knowledge, what a pitiful failure, I thought, crying in front of a little girl who’d been through so much. In an attempt to hide my mistake, I paused briefly to quietly wipe my cheek with the back of my hand. It was in that moment that the girl looked up at me for the first time. I could finally see her thin face and her sad, weary eyes. My tears continued to flow. For a brief moment, she stared at me with a bewildered expression, which gradually transformed into a subtle sense of relief. We said our goodbyes, she thanked me for the session and left.

This is a continuation of the previous post about war and guilt.

Long post alert ⚠️? ~4 min read

Over the past year, I've been contemplating what I, as a psychologist and as a therapist, can write about. The easiest route would be to discuss my Ph.D. research on the mind-space connection, which is closely tied to my previous career in architecture and may resonate with many readers here. However, I perceive this type of writing as more of a job, lacking the vibrant spark that I feel when I reflect on my work as a therapist. I simply couldn’t get myself to do it beyond the requirements imposed by my university.

But then, as a therapist, I face numerous limitations regarding what I can share about my work with people. I meet with several clients (or patients? It’s a debate) each week, accompanying them through their struggles, marveling at the complexities of their human individualities, and finding immense inspiration from them for my thoughts, writing, and personal growth. I gain valuable insights every week, yet I am unable to discuss them in detail due to confidentiality reasons. While I could attempt to protect the identities of those involved by omitting any personal information in my texts, clients might still recognize their own stories, which could potentially disrupt the therapeutic alliance we have. Therefore, I will not do it unless it is an academic case presentation among colleagues, long after the therapy has concluded.

However, there are a few cases from my past training practice that I can touch upon to some extent. These are known as "demonstration sessions" where you meet a client only once, knowing pretty much nothing about them (and vice versa). The entire session is observed by a group of fellow therapists and a supervisor, either in the client's presence or behind a one-way mirror. Consequently, these sessions are often offered to clients for free. Here, I would still sign a confidentiality agreement and naturally avoid using any personal information. But it becomes slightly easier to discuss a specific issue brought up by the client within a more general context without affecting the therapy's outcome, given the absence of a long-term therapeutic relationship.

Last year, I took the opportunity to participate in a demonstration session in Moscow while visiting my family there. Since the majority of my therapy is conducted online in Kyoto, meeting a client in person and receiving face-to-face feedback from colleagues was a rare luxury for me. The client was selected randomly, one person among many others who had applied to a counseling center, willing to undergo a demonstration session in front of a group of professionals to then receive several free regular sessions with a different therapist from the center.

I vividly recall waiting nervously in an uncomfortable armchair, anxiously glancing at the clock, when I heard someone entering the room. Initially, I assumed it was another colleague who came in late since the person appeared to be in a rush, heading directly towards the audience seats without taking their time to look around the room. However, the supervisor caught her there and guided to the couch in front of me. Even then, I could not really believe it was my client – there was nothing in this person’s behavior indicating that they were here for the session.

The girl looked strikingly unusual. She was very thin and wore unisex black clothes with a massive black hood covering her head, hair and top half of the face with her gaze deadly fixed on the floor. It was hard to tell if she was a man or a woman because of this. As she sat, she did not bother finding a comfortable position, remaining on the edge of the couch for the entire session. Her posture was hunched, as if she was trying to occupy as little space in the room as possible, almost as if she wanted to disappear. She never looked up to check who was in front of her, even as she settled in and began speaking.

Apart from the banks that started treating Russian clients with significantly more suspicion to enforce sanctions, no one cares where you come from. Only once when filling one of the countless meaningless bureaucratic paper forms for my Ph.D. course, I got a compassionate “Oh, you’re from Russia. Is your family okay there?” from a clerk at the university administration, which completely threw me off my mentally prepared guilt-ridden schema of “I am against this war” kind of response. Other than that, if your skin is white, you’re automatically classified into the category of “white people” and you’ll get no more or less discriminated against than a generic American, European or Australian. The financial crisis is only evident when your convenience store raises the coffee price from 100 yen to 110 and it becomes a national shock in the news, but you painlessly forget it has ever changed the next week. Your usual comfy expat life continues.

Then comes the curse – the inconsistency of what’s around, and what you know, feel and experience on the inside. You read through the nightmare of daily news and look out the window to find this idyllic calm cityscape surrounded by picturesque mountains straight from the Japanese woodblock prints – and can’t believe anything is real. When the war had just started, we organized a protest demonstration to make at least some of the reality around us correspond to our feelings to be able to share them (pics above). Being in a group of 70 expats with posters, hearing passionate speeches and finally seeing with your own eyes Ukrainians and Russians crying together and sharing their personal tragedies, it seems like the best thing that you could have possibly done at the time. Yet when the event ends and you notice the cozy little park around you with red Torii gates, the indifferent Japanese passersby, busy streets of Kyoto with so much healthy urban life on them, your act of expressing your feelings seems disruptive and inappropriate for the physical context. You start wishing you’d be back in Europe to have this context, but then you talk to your friends living in Europe and they tell you they wish to be back in Russia to feel the “real” thing. Then you finally talk to your friends in Moscow and many of them tell you they wish to be closer to the war zone to have their emotions coincide with reality and stop experiencing this existential guilt of knowing about the horror coming from their country and not being scarred by it themselves. The Ukrainian war victims seem to experience even more dreadful guilt for running abroad and leaving their homes and people they knew in danger – this seemingly counterintuitive feeling of regret is very common for traumatic event survivors suffering from PTSD (I shall tell about my counseling experience with this kind of people later). While these are incomparably different types of guilt, the process helps to visualize a metaphoric whirlpool of trauma. In the center, you have the war zone, where all events are physical and imminent, and most of any possible guilt and existential questions are annihilated by the need to survive. Here, most people try to leave the area as soon as the opportunity arises, because our nervous systems cannot sustain such strains for long. Then, as you are spiraling out, the further you are from the “real” part of the war, the bigger is your radius of “guilt circling” and higher is your velocity of spiraling back. To be continued ~