By Yelena Ivanova, LCSW

My journey as a therapist started out with a great deal of self-doubt about my ability to connect with patients who didn’t speak Russian, given my distinct Russian accent, as well as my ability to attract and maintain therapeutic relationships with patients who did. I began psychoanalytic training while transitioning from working at a clinic as a social worker to launching my own private practice. The demographics of my patients shifted immediately. I began to see more people who came from immigrant backgrounds including first-generation children who were in conflict with immigrant parents alongside of native New Yorkers struggling with daily living. 

While my fledgling practice filled with non-Russian speakers, I found the appearance of Russian speakers to be rare considering my last name and suggested cultural heritage. Patients who did come to speak Russian in therapy had a tendency to leave early on, or to sometimes never even return after that first session. Interpreting this trend, I thought to myself and formulated to my colleagues, the main themes which had manifested in those initiating sessions had revolved around how therapy had never before been a part of Russian culture, referring to the Soviet era and post-Soviet Russia. Divulging one’s secrets and problems to a stranger must have been too questionable an activity, too western a concept. Talking about one’s problems even in one’s native tongue may have been too hazardous, not concrete enough, since, to my dismay, the Russian speakers continued to leave.

After the fall of the Soviet empire in 1991, modern day Russia began to immerse in Western ways of operating, and in my opinion, Russian culture attempted to keep up by also constantly evolving, thus psychotherapy and psychoanalysis gradually moved to the front lines of mainstream culture. TV shows like God Complex, and Psikh (a word that loosely translates to “crazy”), as well as books and radio shows, all broadcasted the immense benefits of the ability to self-reflect, reconsidered how to raise children, and offered new ways to approach interpersonal conflict. Issues once considered taboo now became more acceptable and talked-about problems, specifically difficulties with sexuality, including now even homosexuality. People were looking for safe outlets to express themselves in a contemporary way without being judged. 

Russians all hailed from historically distrustful nations, partially due to the prolonged repression of Stalin’s era, followed by Brezhnev’s stagnation, and landing at the Putin regime. Distrust of a stranger was a sturdy defense built of sound reason based on the hard lessons of history; however, miraculously, people progressively became more open. The notion of confidentiality in Russian culture became tangible. Today, a new generation of Russians are living in a completely different reality as compared to Soviet times. This evolution has contributed to different ways of thinking about what life should be, shifting value systems, managing love and familial relationships, and resolution of interpersonal conflict. Russians have allowed themselves to become louder through their expressions of desire, and, on occasion, by choosing a more individualistic approach to living, as opposed to maintaining the status quo of the collective, which has set the stage for the acceptance of outside help. 

Over time, I slowly accumulated more and more Russian-speaking patients. I marveled that things were changing and seemed to be moving toward more continuity and stability within these particular therapeutic relationships, and I while I appreciated this, of course, I felt curious and surprised about this shift. I asked myself: What is so different? How has the world moved Russians toward expressiveness and openness so rapidly, when they were protectively rigid and closed off before? Is working with Russian-speaking patients actually feasible? Looking back, now, I wonder if, unconsciously, I didn’t originally believe that therapy with this demographic ever could work. Even though I had been convinced that sharing a language and cultural background should be enough to remove every last hindrance, perhaps I too was closed in a way, and this attitude transferred onto my dynamic with fellow Russian-speaking patients, collapsing the space and colluding with their early exits. That form of enactment eventually resolved, changing organically as I observed continuous sweeping evolution in Russian culture.

My experience with Russian speakers turned another crucial corner after Russia invaded Ukraine in February of 2022. To my astonishment, the impact of political events had a profound effect on the therapeutic process in unprecedented yet inevitable ways. Sessions with patients who had already been with me for a while carried more weight. Now an elephant was always in the room with us, and each patient’s own background, political views, and the question of which position that I took during this horrific time came to the fore of each conversation. New patients were now even more guarded in early stages as they attempted to suss out where I stood by how I reacted to what they had to say through my body language, with my eye contact, and by my alternating silence and speech. I noted the new kinds of patients I was getting, older and often more troubled with PTSD. I took in male patients who had served as Soviet soldiers in Afghanistan in the ‘80s. This current war brought up tremendous pain and remnants of bygone trauma, major confusion, disappointment and disillusionment. Many veterans of war were freshly triggered and made the revelation that they had never actually dealt with their deeply embedded emotional and physical wounds, and something about this new iteration of war made it a good time to unpack them.

I must confess that my ability to provide a holding environment at times wavered, was even questionable. Confusion about my own emotions around the conflict and persevering in a steady state of shock, along with metabolizing my conflicted feelings around Russians being perceived and characterized as “aggressors” all took a tremendous toll on me. At times I was wounded by the shrapnel of comments about Russians as I faced yet another explosion of abject hatred in the consulting room. My motivation could occasionally lose steam, and my ability to grasp meaning from some of the content of the sessions was at times impaired, my focus meandered. It could be quite exhausting to follow the convoluted free association of intense violence, horror and mourning. 

Ultimately, I have withstood discomfort and have found the wherewithal to hold the integrity of the therapeutic alliance and frame, for the most part, along with the ordinary missteps and misfirings that befall the impossible profession. Together, my patients and I have tolerated our mutual confusion in pondering the unbearable, and we will continue to do so. 

What has most aided me in helping my patients work through this particularly difficult time of war is the same kind of reflection that has always carried me through, indispensably, since my early days of psychoanalytic training: seeking out the guidance and wisdom obtained through good supervision and maintaining the discovery of fresh new insights in my own personal analysis. 

Yelena Ivanova, LCSW is a graduate of the Manhattan Institute for Psychoanalysis. She is in private practice in Manhattan.

 

 

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