Through a case involving a West African asylum seeker, the author explores the themes common to this population. These themes include working through trauma experiences, dealing with the separation from one¡¯s native culture and the loved ones left behind, a lack of mastery over new surroundings, a loss of language, and a chronic sense of never belonging. The author proposes fostering a sense of belonging in an alien culture by establishing a meaningful connection and close therapeutic environment between client and worker through selective use of transference and countertransference reactions. The aims are for the client to find empowerment through rewriting the damaging narrative and to forge a resilient self concept based on highlighting innate client strengths. These can be illuminated through the therapist¡¯s selective use of self disclosure along with empathic nurture. Rather than impose a Western medical model of recovery, the therapist becomes familiar with the client¡¯s native processes of healing, involving ritual and spirituality, and provides functions of mother, guide, mentor and fellow traveler in the transplanted process toward healing.
T is a thirty four year-old West African immigrant. Fearing for her life, she fled her native country and arrived in New York City at John F. Kennedy airport with nothing but a carry-on bag. She had nobody to contact and nowhere to go. As it happened, she found a taxi driver who was from her region and spoke her language. He took her to the home he shared with another immigrant family where, after a short time, he impregnated her with their daughter K.
The first time I met T at the agency to do an intake, she tearfully took a photograph out of her handbag and thrust it across the table to me. ¡°Here,¡± she said. ¡°You better keep this, to give it to K when she is older; it is all that I have of her father.¡± I looked down at a grainy image of a dead man laid out in funeral finery. ¡°But why me, T? Where are you going?¡± That moment of desperation was a harbinger of T¡¯s wrenching narrative of trauma and loss, which has provided both the latent and manifest substance of our work together, as well as being a prominent feature of our respective transferential and countertransferential feelings.
Before T became homeless in a foreign country and lost in an alien culture, she was a Muslim first wife and mother of two children in West Africa. When political and ethnic tides turned, T¡¯s husband was imprisoned, tortured and killed. Shortly thereafter, T¡¯s husband¡¯s second wife died, and following tradition, T became the mother of her two children (who T says she loves as if they were her own). Not long after the death of her husband and his second wife, T was picked up and taken to jail. She was threatened with warnings that what had happened to her husband would happen to her, too. She was repeatedly sexually humiliated and raped, cut with knives, and burned with cigarettes.
T¡¯s brother bribed a jailer, took her to a neighboring country under a false passport, and put her on a plane bound for the United States. Through this life saving intervention, T became abruptly separated from all that defined her: her four children, her siblings and extended family, her village community, and perhaps most importantly, her mother, to whom she is strongly attached and with whom she maintains a powerful connection through visions and precognitive dreams. Standing on the curb outside the airport in Queens, T began the cycle of loss common to immigrants, even those who arrive here without the violent and traumatic baggage T carried: ¡°a loss of mastery over surroundings, a concrete loss of family networks, a critical loss of language, and an erosive loss of the everyday life… a chronic sense of never quite belonging anywhere¡± (Imberti, 2008, p. 38).
So where was I to begin with T? What was the first step toward nurturing a feeling of belonging? As Noonan (1998) points out, no matter what one¡¯s preferred definition of transference, establishing a meaningful connection or bonding from the client to the worker is both crucial for transference to happen as well as necessary, as it is in the transference that the work happens (Noonan, 1998). Given our obvious differences– T is a Muslim, dark-skinned, poor, illiterate, twice-widowed, asylum-seeking woman from a corrupt and increasingly lawless country with radically different cultural norms and practices from my own, and I am a white, middle-class, educated, Episcopalian woman with a husband and two children who are around to kiss me goodnight every night– I was eager to provide a holding environment that was cushioned with the comfort of familiarity. I disclosed to T early on that I was also a mother and that I had lived in two West African countries (neither one her own). We have spoken French throughout our sessions together, though neither of us can claim it as our mother tongue or our heart¡¯s language. Comas-Diaz and Jacobsen (1991) point out that transference reactions in interethnic therapeutic dyads in which there are significant power differentials are often observed to be either overly compliant and friendly or suspicious and hostile. As both of us sometimes have to struggle to find the right, or the ¡°almost right,¡± word or expression, I believe that this has served to level against obstructive transference reactions. ¡°You are so good. I don¡¯t know who sent you to me but I know that you are good.¡± These two sentences, spoken with tearful emotion by T, are representative of her overall transference toward me and are indicative of a ¡°positive transference in which the worker is viewed as a benign parental figure…to facilitate the process of identification, to affirm a sense of worth, to encourage adaptive attitudes and behavior, or to provide an emotionally corrective experience¡± (Goldstein, 1995, p. 205).
In addition to providing a parental or caretaker role by helping T gain access to the myriad concrete services she and her young daughter need as they labor to heal, acculturate, and construct a life for themselves in New York, I would propose that T sees me as a benevolent guide, part mother figure, part witch or spirit, who is helping her to make meaning from her suffering through bearing witness to what Winnicott (1988) might call her ¡°unbearable agonies¡± (Babies and their mothers, as cited in Applegate, 1993, p. 7). She is also inviting me to take part in what Sparrow (2008) identifies as progressive therapeutic triangles, composed of a ¡°seeker, mediator, and higher power¡±. In our particular therapeutic culture, I would substitute ¡°higher power¡± with ¡°spiritual connection¡± to describe the framework T needs to facilitate a representation of the kind of sacred, healing ritual she might have had back home. As Sparrow (2008) states, ¡°therapists who accept the role of mediator/mentor may perform a sacred function that is needed in this world without representing themselves as agents of any particular religious tradition, or as substitutes for priests and ministers¡± (p. 788).
While my understanding is that T¡¯s early object relations and attachment needs were met, she has lived through repeated betrayals by significant others, beginning at age 10 when her father took her from her mother to be circumcised, without anesthesia, with a group of other young girls. Her sister subsequently bled to death following the same ¡°ceremony.¡± Her sister¡¯s and her husbands¡¯ deaths, as well as her experiences of extreme abuse in jail, have served to break down whatever previously constructed and internalized schema she had developed around protection and safety. I construe observances of resistance on T¡¯s part to be ego protecting, in order to guard against the ¡°reactivation of past trauma…reinjury, and disappointment¡± (Kohut, 1971, 1977, as cited in Teitelbaum, 1991, p. 121). The defensive forms of resistance in T that I have witnessed most frequently are projection, somatization, and splitting, which I feel represent understandable uses of defenses for one who has experienced extreme and ongoing trauma.
Early in our relationship, T often expressed distress over the fact that K¡¯s deceased father¡¯s family wanted nothing to do with her or K. ¡°She¡¯s always coming up to me and crying and saying ¡®Where¡¯s my Daddy?¡¯¡± T stated. K was only about two when her father died, and as the father had abandoned T and K and moved to another state before his death, I think it is unlikely that K misses or even remembers him. What I think is more likely is that T is projecting her own overwhelming feelings of rejection, loss, and abandonment onto K. I also think that ¡°Where¡¯s my Daddy¡± may signify K¡¯s need for more nurturing than her courageous but wounded mother can provide.
T presented with many classic symptoms of Post-traumatic Stress Disorder (PTSD), including recurrent thoughts and nightmares, heightened arousal, severe insomnia, and poor concentration (Bracken, 1998). She also suffers from symptoms not included in the western medical model of PTSD but widely seen in torture survivors, asylum seekers, and refugees, such as skin tingling, heart flutters and chest pressure, breathing problems, headaches, and vertigo (Rasmussen, Smith & Keller, 2007; Renner & Salem, 2009). We usually spend the first part of our sessions going over T¡¯s ailments, which include all of the above, and while there is a medical explanation for some of them, I think they are somatizations of the psychic pain she can neither wholly contain nor effectively release. The focus on the physical manifestations of her suffering indicates a form of resistance because it takes the focus off of dealing with the more uncomfortable and debilitating reality of her psychic injuries. Usually, the medical conversation serves as a segue into what is really going on with T. This is evidenced by the following exchange, when T and I have just finished talking about her headaches and excessive thirst, which contribute to her wakefulness at night:
SW: Are there any other reasons you think you might have difficulty sleeping?
(T becomes tearful) T: I close my eyes and I think of all these terrible things; all my worries…All these bad things, the
things that happened before; my mother saw many of these things, and I see them, too.
It is reasonable to think that even if T had acceptable self and object representations as a very young child, integrating and maintaining her good/bad self and good/bad objects will be a challenge given her subsequent life experiences. The above dialogue might also suggest that T did not successfully complete the separation-individuation phase, causing her sense of self to remain entwined with her mother. T uses splitting as a defensive resource to guard against feeling gobbled up by the bad. I am solidly in T¡¯s good object compartment, as I provide care and ego supportive nurturance to her and have, so far, not let her down. On the other hand, according to the caseworker at the shelter where T lives, when a charity worker who had also previously been ¡°good¡± by letting her select clothes from a free distribution site suggested that she already had taken a lot of clothes and that she should leave some for others, T became enraged and hysterical. When I spoke to her later in the day, T was still crying and very distraught. She connected her emotions to feeling like she had been ¡°kicked in the stomach.¡± In terms of the feelings aroused, the charity worker¡¯s denial of a handful of used clothing may have been reminiscent of the denial of her humanity and self- hood in jail, where she was, in fact, kicked in the stomach.
As disparate as our life narratives appear on the surface, T and I share an abundance of feelings surrounding abandonment and loss and a search for ways to heal. Like T, I keep a powerful connection with my mother, even after her death. The circumstances surrounding that death were sudden and violent, though they were all played out in a controlled hospital setting. My prolonged grief and difficulty in accepting my middle-aged orphanhood necessitated an unintentional quest to transcend the loss. Saari (1986) defines countertransference as coming from a ¡°combination involving a stimulus from the patient, an existing meaning system within the therapist and conditions within the external world¡± (p. 44). When T describes the visions she shares with her mother, it stimulates my empathic feelings of wanting to stay connected to my mother. My countertransference is part of a larger system of meaning, characterized by loss and longing. The overlap of our shared external world is that we are both separated from our first and most beloved objects, and that one way to mollify those painful feelings is to accept the possibility of a spirit connection. T¡¯s mother visits her in dreams, often helping her to carry something or to help her find her way when she is lost. Sometimes, when I am at the kitchen window, a mourning dove will sit on the terrace railing in front of me and look at me with her head cocked sideways. I sense that she is my mother¡¯s spirit, taking on another form, and dropping by to reassure me that I have not been abandoned.
Another social worker might be concerned that T¡¯s interest and desire in talking about her psychic connection to a love object and to a spiritual world is negatively resistant, in that it could be seen as avoidance of dealing with her current reality. I see it as a necessary component to the larger goal of taking control and editing her narrative in a way that provides her the meaning necessary to heal. I think my countertransference in this area has been useful to T¡¯s healing process, as it enables me to respond to her quest to make connections and find meaning with empathy, understanding, and encouragement.
When T projects her own yearnings onto her children, such as with K and ¡°Where¡¯s my Daddy¡±, or in describing how much her children left behind in Africa miss her and want to come live here, I experience induced countertransferential feelings associated with my five year-old self. I wanted to take care of my mother when my father left, I suffered acute separation anxiety after their divorce, and I maintained a fantasy that my father would miss me and come back. These feelings arouse my concern that T will not be able to meet her daughter¡¯s developmental and emotional needs, and that K will thus assume the role of emotional caretaker. I have observed K¡¯s anxiety and urgent attempts to soothe when she sees her mother crying and pleads, ¡°Mommy, here I am, I love you, you promised not to cry anymore.¡±
For the benefit of both mother and daughter, I have followed the first four of six tenets of an ego-supportive intervention proposed by Hollis (1972). These include sustainment, direct influence, ventilation, which is broken down into manageable chunks, and person-situation reflection. I tread lightly in the areas of pattern- dynamic reflection and developmental reflection, as I think they are inappropriate to the scope of the therapeutic work and may arouse feelings of intense anxiety in T, which could lead to retraumatization (Hollis, 1972, as cited in Goldstein, 1995). I direct significant attention toward aspects of what Goldstein (1995) added to the Hollis canon: ¡°educative techniques, consisting of providing the client with information essential to functioning in various roles or in negotiating external systems… and structuring techniques, consisting of partializing problems, focusing intervention on key areas¡± (Goldstein, 1995, p. 170-172).
Considering that when I met T she was still struggling to satisfy her most basic physiological and safety needs (Maslow, 1943), my interventions were most immediately centered on these educative techniques that could help her access the systems she needed to survive and thrive in this country. Her illiteracy, language barrier, minority within a minority cultural status, undocumented legal status, and precarious emotional state make T a system of one trying to adapt to her environment in a fairly closed larger system without a roadmap. While T and K still live in a shelter, K is now attending a head-start preschool program and T has found regular work in a hair-braiding salon where she earns enough money to buy clothes, food, and metro cards, and even sends money back to her mother and children in Africa. It is still an uphill climb. The outcome of T¡¯s asylum application is uncertain, and until she becomes literate she will have difficulty accessing the social and institutional systems available to her. She will also continue to struggle with feelings of inadequacy in the face of K¡¯s rapid learning and language acquisition. The incremental progress on relieving some of the most daunting migration and acculturative stressors in T¡¯s life has allowed for the beginning of the recuperation of her play area, defined as a creative, potential space of experience between a person and her environment where one feels alive (Winnicott, 1967). He states that the play area ¡°depends on experience which leads to trust . . . it can be looked upon as sacred to the individual in that it is here that the individual experiences creative living¡± (p. 103).
Have I facilitated this as part of a ¡°corrective emotional experience?¡± Probably , but it was T who drove the good object reenactment and guided me toward what she needed: ¡°the need to experience admiration and security; the need to feel contained; the need to experience that all feelings can be manageable, even negative feelings… the ability to manage certain degrees of separation and intimacy in relationships without feeling excessively abandoned or en- gulfed¡± (Knight, 2005 p. 34)
The last time I met with T, she was feel- ing sad. She stated, ¡°I¡¯m trying so hard to do everything right, but I¡¯m still alone here, and I wonder, I ask God, ¡®Why did you bring me to where I am?¡¯¡±
After exploring those feelings and all the progress she has made, T brightened a little and said, ¡°A long time ago, before I came here, I had this dream and it was full of white people, carrying bags and moving around, and I didn¡¯t know why I was there or where I was going, but now I see that I was coming here.¡±
¡°So you found your way?¡± I asked. T laughed. ¡°Yes, I guess I did.¡±
Applegate, J. (1993). Winnicott and clinical social work: A facilitating partnership. Child and Adolescent Social Work Journal 10(1), 3-19.
Bracken, P. J. (1998). Chapter 2: Hidden agendas: Deconstructing post-traumatic stress disorder. In J. Bracken & C. Petty (Eds.), Rethinking the trauma of war (pp.39-59). London: Free Association Books.
Comas-Diaz, L & Jacobsen, F.M. (1991). Eth nocultural transference and countertrans ference in the therapeutic dyad. American Journal of Orthopsychiatry, 61(3), 392-402.
Goldstein, E. (1995). Ego psychology and social work practice. New York: The Free Press.
Imberti, P . (2008). The immigrant¡¯s odyssey . Psychotherapy Networker, May/June, 35-39, 50.
Knight, Z.G. (2005). The use of the ¡°corrective emotional experience¡± and the search for the bad object in psychotherapy. American Journal of Psychotherapy, 59(1), 30-41. Maslow, A.H. (1943). A theory of human motivation. Psychological Review 50(4), 370-396.
Noonan, M. (1998). Understanding the ¡°difficult¡± patient from a dual person perspective. Clinical Social Work Journal 26(2), 129- 141.
Perez-Foster, R. (2001). When immigration is trauma: Guidelines for the individual and family clinician. American Journal of Or thopsychiatry, 71(2), 153-170.
Rasmussen, A., Smith, H., & Keller, A. (2007). Factor structure among West and Central African refugees. Journal of Traumatic Stress, 20(3), 271-280.
Renner, W., & Salem, I. (2009). Post-traumatic stress in asylum seekers and refugees from Chechnya, Afghanistan, and West Africa: Gender differences in symptomatology and coping. International Journal of Social Psychia try, 5(2), 99-108.
Saari, C. (1986). The created relationship: Tranference, countertransference and the therapeutic culture. Clinical Social Work Journal, 14(1), 39-51.
Sparrow, G. (2008). Progressive triangulation in psychotherapy and the spiritual journey. Mental Health, Religion & Culture, 11(8), 783- 793.
Teitelbaum, S. (1991). A developmental approach to resistance. Clinical Social Work Journal, 19(9), 119-130.
Winnicott, D.W., (1967). The location of cultural experience. International Journal of Psycho- Analysis, 48(3), 95-103.
About the Author
Kendall Pron is a graduate of the University of Texas. She majored in English and minored in Psychology. Before coming to HCSSW, she lived for many years in West Africa and Southeast Asia where she worked as a consultant for Unicef and USAID. Her first year placement was at the Sauti Yetu Center for African Women where she worked primarily with West African asylees and asylum seekers. Her second year placement was at the Postgraduate Center for Mental Health at the Center for Adult Psychotherapy. Her major method at HCSSW was Clinical Practice with Individuals and Families. Kendall can be reached at email@example.com.