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					"Linking the Breaks": a group experience of psychoanalytic psychotherapists to the xenophobic violence in Cape Town.
By Astrid Berg, Judy Davies, Kathleen Hanley, Andrea Hill, Jenny Perkel, Diane Sandler and Jane van der Riet In this talk tonight, the seven co-authors describe and reflect on the experience, over a 3–4 month period from June to September 2008, of offering volunteer mental health services on a regular basis to refugees at various sites in response to the xenophobic crisis in Cape Town. In particular, the authors focus on how a group of about twenty therapist volunteers felt about the work, how they thought about and communicated those feelings to each other, and the way of working that emerged over this period. The notion of a relationship between this form of linking up with each other, via both email and meetings, and the therapist volunteers’ capacity to continue to provide a particular therapeutic service during a humanitarian disaster of this magnitude are explored. Some Background Reports of violence against black foreigners and immigrants in South Africa are not unfamiliar. Indeed, they have increased over the years. However, the scale and level of violence that erupted in May 2008, first in Gauteng and a few weeks later in Cape Town stunned, horrified and fractured us as a nation. It rapidly enveloped many areas in greater Cape Town. People of all walks of life responded in many practical ways, donating clothes, groceries, and household items. It seemed that whole areas of Cape Town were mobilised in an unprecedented way. Within days of the mass displacement, at the end of May, a call went out on email from the Cape Town Trauma Centre asking for volunteer mental health-workers. The Trauma Centre had been mandated officially by the City of Cape Town to take on this co-ordinating function. Among the many volunteers was our group of about twenty therapists, most of whom were members of the Cape Town Society of Psychoanalytic Psychotherapy (CTSPP) but which included several therapists based at the University of Cape Town, as well as three unaffiliated therapists. Of course, our social and personal identities were woven into our conscious and unconscious responses to the victims of this crisis. Our group was mainly white and female, with one black African, two coloured and two male therapists, all of us belonging to the middle class. Except for two colleagues, all were in full-time private practice. Though many other therapists, including members of the CTSPP, were involved in some way, it is to this core group that we generally refer in this paper. No doubt, the intensity of this group of therapists’ feelings in relation to the xenophobic attacks was linked to feelings stirred up by a shared South African history of apartheid and colonialism or for some being immigrants themselves or from previous generations. Hill and Poss (2009) suggest that trauma may trigger a ‘shared South African phantasy’ of guilt for many white South Africans. Other factors that may have influenced some of the responses of the writers of this paper are unconscious phantasies of not really belonging to South Africa, of having no real ‘right’ to be here and of feeling vulnerable to attack by a majority sometimes feared to be enraged, envious and deprived. Therefore, by wishing to protect the victims of xenophobic violence, we unconsciously may have wanted to protect ourselves. A further facto was the

opportunity to express empathy for traumatized, vulnerable people (P.Gobodo-Madikazela 2008, unpublished) In the literature, there is significant debate about the usefulness, or lack thereof, of a psychoanalytic approach to trauma counselling (Boulanger 2002). Indeed, psychoanalysis continues to be criticised for not being sensitive to harsh realities that psychologically impact on people when these are not linked directly to developmental deficits or infantile conflicts (Boulanger 2002) Further, according to Garland (2002), trauma disrupts the core of identity, and addressing that level of disturbance is not something that can be done quickly or easily. However, these ideas seem to confuse psychoanalysis as a method of clinical intervention i.e treatment, on the one hand, with a clinician’s psychoanalytic state of mind and thinking that can be applied to various situations and settings, on the other. Thus, the debate has never been about whether psychoanalysis can be helpful as a way of thinking and understanding; rather, it concerns how psychoanalysis can be adapted and applied.In particular for us, to the unstable, unpredictable and ever-changing conditions we found ourselves in. We remained acutely aware of this conflict throughout, cross-examining ourselves constantly, and endeavouring to understand and reflect on what we were doing, how we were doing it, and whether it was useful. Of course, this is part of the psychoanalytic method. Nevertheless, in the midst of such vast need and pain, we had tostill somehow find our own way, offering what mostly seemed to be very little. Paradoxically, however, because of the emotional impact on us, it simultaneously felt that we were giving an enormous amount as our capacities always felt stretched to the limit.

We were advised by the CT Trauma Centre to apply a widely accepted model of intervention for mass disasters, devised by Hobfoll et al. (2007). This method focuses on promoting a sense of safety, calm, self- and collective efficacy, connectedness and hope. Although the Hobfoll approach has been received positively by many authors – for example, Weisaeth et al. (2007) and Tuma (2007) – there is very little evidence of the success or failure of psychological interventions in disaster mental health (Hobfall et al, 2007; Tuma, 2007). Weisaeth (2007) has noted that research suggests that practical and pragmatic support, as well as empathy and information, should be important immediate elements of trauma response. In addition, psychological debriefing, according to some studies, has been found not to have been effective. All of this could not be debated at the time – we found ourselves in a situation where we had to discern how we could make a difference as psychotherapists as these sound theoretical premises did not hold up in the unfolding reality. Our experience of working with the victims of xenophobia, displaced from their homes and staying in refugee camps and a church hall, was that it was an unpredictable, messy, uncoordinated and fragmented reality, with no place and no space for employing well-intended treatments and therapies. In these situations of ongoing, cumulative, and present trauma, what we could offer was the continuity of our mindful presence. We believe that, for someone who is traumatised, for them to be able to remember, and to possibly even savour, a good experience in a relationship, is perhaps a small gain, but an extremely important one, one which can be built upon in future more favourable circumstances.

We knew that there were limitations in what we were offering therapeutically, but we felt there was something beneficial in our presence for the displaced people.

Our intervention We worked in four very different settings over a period of three to four months. None of us had the experience of visiting all four sites. The differences between the sites were significant, and so our individual experiences were varied. Site 1 The first site was a financially well-resourced, historically politicised church in the suburb of Rondebosch. For those who began at this stage and attended this site, the experience was a stepping-stone and source of learning for a way of working. Colleagues visited in the evening, accompanying each other in twos and threes for a designated time of one hour. A roster developed and these practical factors provided a frame for the visits. After visits, we wrote about our experiences on email to each other and to those colleagues still waiting to do some work. A virtual group process began in which daily accounts of our experiences were read, digested and sometimes responded to. This technique of observing and recording thoughts and feelings was akin to that of infant observation and was central to our capacity to keep links internally and between ourselves. One such email, indicating a colleague’s observations, descriptions and attempt to convey the atmosphere on the night, reads as follows: There was a calm atmosphere with about thirty or so people in the hall. Mattresses and bedding began to be taken out around 8:15pm. We were not introduced formally as the organisers seemed busy and so just sat down with some people. [One of us] spoke in French with [a man from the DRC] and his wife. She felt that he was fairly contained this evening and had plans to stay with some people in the near future. On that same evening, the children at the church seemed very uncontained, and one therapist was urinated on by a young child. The colleague was overwhelmed by this aggressive and uncontained act and was not able to respond at the time. In retrospect, it was felt that the shame and helplessness of the refugees could not yet be talked about by anyone. Site 2 Simultaneously, one UCT-based CTSPP member was asked to help with mental health issues at another site, housing between one to two hundred people. This was in a City Council hall, the at the Chrysalis Academy, situated in the suburb of Tokai, which was being serviced and run by volunteers. This UCT colleague was aided by a child psychiatrist and Jungian analyst, also a UCT Department of Psychiatry staff member. Trainee psychologists at UCT were then organised for one month on a roster basis, for 2-hour weekly slots. Eventually, a volunteer from the CTSPP joined in on a Saturday afternoon. Nevertheless, colleagues were called at all times of the day and night to intervene in many crises that arose at this site over the months. Site 3 The third site was a massive tented camp at Youngsfield military base, near Wynberg, accommodating a few thousand people initially, and about 700 people by the end of September

when all remaining sites were officially closed. It was situated in a wide-open space, vulnerable to the winter elements; at the end of August, a severe storm created fresh chaos as it flattened a majority of the tents, leaving people homeless and without their belongings again until new tents could be set up. Like the other major sites, Youngsfield was managed by the City of Cape Town. Five members of our group went to Youngsfield on a semi-regular to regular, weekly basis. “He [a young man from the Democratic Republic of Congo or DRC] was complaining of headaches but has no other physical complaints. He has been in the country for 5 months after losing all his immediate family in the DRC. We spoke in his tent, at his request, and it was neat and spacious with not too many beds, all made up except for the one we sat on which was not being used. He is alone and has nothing but his documents but was neatly dressed in clothes which he said had been donated to the camp. He seemed quite depressed and was tearful talking about his experiences. It was the first time he had spoken about this since leaving the DRC.” “inside there were no chairs available so I spent the hour standing and talking to various men who approached me – not ideal…re-enacting an unbounded context, but also inevitable as supper was being served and there was much going on.” Site 4 A fourth site was serviced by about 11 CTSPP members. This was a community hall in a suburb near Century City, Summer Greens, about ten kilometres from the city. It housed approximately 300 people. Some of the chaos is reflected in the following email: I needed to sleep on the whole experience before I could make sense of it. I had an overwhelming experience of being intruded on [by the high noise level and the very active presence of two little toddlers who crawled over me and the children and kept taking the pens!] This of course mirrors the experience of the children... most of whom seemed to be responsible for the ‘little ones’ and there was an absence of parental involvement. At all the sites, many of us felt a pressure to provide something concrete. We were repeatedly asked for practical assistance (for example, help with issues related to the Department of Home Affairs, employment, food, money and clothing). In this ongoing trauma of mass displacement, in a context of political inefficiency, the tension of when to actively provide and respond to external needs or provide for internal body/mind needs was always present. This is, of course an everpresent tension in applied psychoanalytic community work, and specifically reugee work, and always demands a thoughtful and humane response. Thus, we did play a role in communicating with authorities, providing information, offering practical assistance, etc. Displaced people felt strongly that their concerns regarding site conditions, how long the sites would stay open, and issues of safety and security once they left the site were not being effectively heard or addressed by the Province and City Council staff. They seemed to feel that they had only us and other volunteers to hear them. The following extract, detailing a refugee’s plight, is typical of virtually every refugee’s experience of loss and desperation during the crisis: Mr H (26), from Somalia, is married and has four children, two of whom are disabled. He had a shop in Dunoon and earned well until it was looted and

repossessed by the owner. He has not paid rent for 3 months and his belongings are still in this house to which he has no access. He is numbed by his losses and does not know where to start again. He is a businessman and he says Somalis run four types of businesses here in SA. Groceries, Hawking, Deliveries and selling wholesale airtime. He is desperate to get out of the camp and find a job. His number is *. Any suggestions?

Some volunteers felt they could not continue past the initial stage of the crisis. Those who could, including our core group, settled for the most part into weekly visits with a predictable day and time. At Summer Greens, where there were more therapist volunteer resources, this meant visits covering, between us, several sessions each week. Initially, when we started visiting the sites, despite attempting to get the setting right by obtaining the permission and support of those ostensibly in charge. The conditions at the sites made traditional psychological interventions impossible. There was no designated, private space available, and at one site there was always a battle to find two chairs on which to sit to talk to our ‘patients’ However, the diversity of the refugees’ experiences, as well as the range of their needs and capacities, including different levels of fluency in English, meant that we continually had to adjust our expectations of what we might offer. Being there in this unstructured and unpredictable manner was very uncontaining for us as it robbed us of our familiar co-ordinates of place, space and privacy, which we are usually able to control. This countertransference experience of being without resources and having no control was not easy to work with alone. Therapeutic interventions took many different forms at the different sites, including: these regular, ongoing visits with set times, which allowed for the observation of vulnerable people and children; assistance in the admission of refugees to psychiatric and medical facilities; referrals to day hospitals for specific medication for post-traumatic stress disorder (PTSD); the organisation of workshops for futures planning; the organisation of a drum circle and yoga exercises to alleviate bodily tension; and the facilitation of group processes that spontaneously developed. These group processes enabled some refugees to tell their stories(debrief) or air their grievances. Some counselling about future options was offered in small groups and individually; arrangements were made for church attendance; counselling (in one-to-one conversation) was provided to support work and study initiatives; and information sheets listing resource groups that could be accessed were distributed. We became links in a chain, often trying to assist in overcoming the disrupted nature of the situation. Consulting with, and supporting camp coordinators played an increasingly large role for many of us, as did supporting the personnel in charge of the kitchens and the children. One comment follows- a response to being asked if it felt helpful that we came: [One man] said ‘We like it, Mama. When you go to bed at night it gives you something very nice to think about and remember. I sleep better when you come’. Others in the group agreed and also said ‘You see, and you can tell the others.’

However, the emotional impact of these interventions on us cannot be underestimated. A brief vignette illustrates this: Our small group could drive easily and swiftly to the refugee site. However we were unable to leave in the same way. Whoever drove home would become lost, puzzled and confused. We could laugh and appreciate this enactment, an enactment both of the refugees’ experience of being lost and confused but also of our own guilt. How could we return to the certitude of our comfortable homes when they could not? The challenge for us was to try to provide some continuity in a group reflective space, as different colleagues visited the sites on different days and at different times. Again, for the sake of ourselves and the efficacy of the work we were doing, we communicated with one another constantly via email about our patients, the sites and our feelings about the work. Feelings about the work included despair, helplessness, pointlessness, terrible anger at the authorities both local and national, appreciation for meeting people from different parts of Africa and gaining in knowledge about lives lived elsewhere and on the margins within South Africa. Some colleagues felt shattered by the weekly visits and dreaded going. Some became drained of energy, angry with their families and sometimes depressed.

Linking the breaks for the therapists It became clear to us that there was an important connection between trauma and breaks in linking, with the resultant collapse of symbolic functioning -leading to action without thought. Trauma ruptures the capacity to distinguish between thinking, remembering, imagining and the actual event of trauma. The trauma of the xenophobic crisis appeared to interrupt the thinking process, for both the victims and the therapists. The vastness and extent of the disruption, touching so many thousands of people, coupled with the enormity of each individual’s loss was overwhelming for victims and therapists alike. Intense fear and anger, as well as hopelessness, often manifested in the refugees’ communications with us, and our feedback to each other included expressions of how hard this could be to hold. This was even more in evidence in our unrecorded face-to-face meetings as colleagues. In these meetings, feelings of hopelessness, anger and disbelief, as well as confusion and uncertainty, could be expressed authentically in a mutually supportive environment. Our contact with one another, and our sharing of emotional responses constituted a therapeutic linking of the breaks, enabling us to continue working at the sites. Crucially, this happened not only through mutual emotional support, but also through discussing and reconnecting with familiar psychoanalytic concepts: [As] we either drove in groups to the site at night, or in the day, or [driving] individually through leafy suburbs, [we knew] that on reaching our destination [there] would be a parallel world of trauma, helplessness, despair, anger, paranoia and confusion. All we had was our professional training, and in particular our internalisation of psychoanalytic theory and thinking and our own moral code. (See Rustin, 2001)

A shared, psychoanalytic understanding about what we experienced, observed and felt working with victims of xenophobia served as a crucial intellectual container for us. The fact that we were all professionally located in psychoanalytic theory made it possible for us to communicate meaningfully with one another, using a common language to understand the complex circumstances of this particular work. How we used psychoanalytic theory to make sense of and contain our painful countertransference experience will still be discussed later. However, what is clear from the following quote is how our analytic attitude and sense of professional efficacy was disabled by our contact with the refugees: I left feeling anguished and helpless and also not clear that I had been of much use…I feel so trapped in wanting to just hand over cash, to at least help a few individuals get on their feet...but it is so much larger than that. At Youngsfield, with only five therapist volunteers, it was not possible to create a roster of visits to the site, but communications of proposed visits were sent, along with reports on visits, via email. The process of linking with each other via email and the group meetings became essential. The circumstances at the sites remained fraught; the leadership from the City and the Province, who were not on speaking terms due to their different political affiliations, continued to be experienced as non-existent, resulting in burnt-out and frustrated working staff, frequent staff turnover, and confused and confusing communication. All of this served only to prolong feelings of destabilisation among the culturally diverse, and sometimes rival, refugee groups. As professionals offering a service in this crisis, we had to find a way through these feelings to something more helpful. Our experience was that the inadequate communication between authorities created a fractured environment in which nobody knew quite what was going on. In this context, our communication, through the regular visits, with the refugees, with the authorities and with one another also felt like a linking of the breaks between the unmetabolised and confusing bits and pieces of reality about the lives and the future of our ‘patients’. The writing up after the visits, which was shared by email, and our meetings offered us two forms of processing, sharing and being contained, which seemed vital to sustaining the visits and allowing us not to act out our frequent wishes to deny and avoid the sites, while remaining more committed, mindful and receptive. Our professional training, in infant observation which is encapsulated in the 2 phrases “Listen with the Heart” and “ watch, wait and wonder” (Prat, 2008) for example, had prepared us for these difficult states of mind and for using the containment of our e-mails and therapist meetings in an unselfconscious way. Perhaps, the model of infant observation, with its discipline of observing and registering primitive feelings without inappropriate intervention, helped us more than any other. Also, from our experience of infant observation and the psychoanalytic framework, we would always arrive at regular times and were mindfully available for a set time before making our goodbyes to the refugees, the gatekeepers and others. Some bits of theory Possibly the most central defensive process that was identified throughout our work was projection.

Projection, the defensive ejection unconsciously of one’s own unacceptable or unbearable feelings and placing them somewhere else, appeared to function at all levels of this crisis. It was operative during the original violence of victim/perpetrator and was activated in the helpers and volunteers. Helplessness, rage, despair, isolation, shame, paranoia, numbness and grief were feelings we all experienced to varying degrees, feelings which we transferred to some extent and in various ways onto each other, and onto our families and onto the authorities/government/Trauma Centre. Of course, each therapist’s experiences were unique. Some of the authors of this paper remember the following examples: • noticing how we become more tearful, irritable, impatient or thin-skinned than usual with family members; • needing to not talk to anyone after a visit, but instead to eat chocolate and switch off by watching TV or going shopping; • occasionally flaring up in a disagreement with a colleague; • fearing being judged by colleagues for stepping ‘out of the conventional frame’; • wishing to avoid or dreading reading newspaper articles about ongoing human rights violations in the camps; • dropping energy levels, a sense of being emptied out, which lasted for months; and • feeling shame that the brief once-a-week visits could leave us so shattered when the refugees had no respite from their experiences. • Rage and fury at authorities/government/Trauma Centre/Psychiatry department/Heath Clinics

It is highly likely that these feelings were projected onto us by the refugees, as well as arising from our own histories. To some extent, they may also have been stirred up by our own dynamics as South Africans with a complex political history; for example, being overwhelmed by the depth of trauma experienced in South Africa (and throughout the continent of Africa), as suggested by Hill and Poss (2009). Many of us experienced an uncharacteristic level of anger at the authorities that were seen to be failing both us and the refugees. It was as though we and the refugees had become one: we identified with them and became outraged on their behalf. A projective identification, i.e. unconsciously lodging unwanted feelings into someone else’s mind and having them carry,feel and act it out for you, had occurred that was powerful and led to action, such as joining the Treatment Action Campaign (an HIV/AIDS lobby group) in taking the Provincial Government to task for its failure to provide camps respecting the human rights of the refugees and writing a group letter to the newspaper. While this was acting outside the traditional therapeutic frame, we felt justified in having done something practical about a situation that was unbearable and unacceptable. We strove to try to understand the less conscious aspects of our motivation to feel and act in particular ways. Often, we did not know why we were doing or feeling things and it was only by waiting, thinking and sharing with colleagues – and also

by writing this paper many months later – that understanding could come, slowly and painfully, in bits and pieces. Only then has it become possible to truly connect consciously to our professional roots and practices. Containment of the therapists Winnicott (1955) has suggested the importance of what he called “the holding environment.” This refers to the function of a sufficiently available, responsive thinking and feeling mother or primary caregiver The absence of containment in the broader context of the xenophobic crisis and at the sites was experienced at numerous levels. Because of our own understanding of this aspect of psychoanalytic theory, we were better able as colleagues to tolerate each other’s varying states of distress, drawing on a combination of professionalism and basic human empathy. However, for many mental health volunteers, the experience was too searing, forcing some to stop visiting the sites; consequently, the original mental health volunteer group, in its larger as opposed to our core group, was amorphous and splintered. In the absence of external frames such as clear roles, appropriate physical spaces, reliable avenues for referral, or even occasional meetings to provide consistent sources of information, we ran the risk of colluding with the apparent lack of mindfulness of the authorities. We, therefore, had to be vigilant with ourselves in order to preserve such things as confidentiality in individual parking-lot conversations and reliability in attendance, even during the many midwinter storms that turned e.g. the tented Youngsfield site into mudflats. With reference to the title of our paper, a bit of explanation: According to Wilfried Bion (1959), when the primary caregiver/mother/psychological container is inadequate or fails to hold intense emotion, particularly hatred, aggression and fear, this may lead to a breaking down of the psychological/mental link between infant and mother. Bion states that when this occurs, intense emotion that is felt to be too powerful to be contained by the infants immature psyche, is hated/attacked. He calls this ‘attacks on linking’. A kind of antiknowledge state of mind. To stress-This is an internal, unconscious process of thinking stopping, i.e within an individual psyche, and thus linking between minds of individuals stopping or breaking down. This was constantly in danger of happening in our work with the refugees, partly because the context was so painful and overwhelming and partly because it was so uncontaining. Many of us longed to stop going to the sites, but those of us who persisted did so because we felt contained enough by our colleagues to bear the pain of the work. The challenge of working constructively in this environment meant we needed to find the balance between an inevitable sense of betrayal and consequent anger at the numerous failures of the ‘parental’ authorities, on the one hand, and an acceptance of the reality of the ‘compromised container’ or situation, on the other. A degree of acceptance of the fraught situation, was necessary in order to create the mental space to do any potentially meaningful work. III The ending stage The dissolution of the camps was a prolonged and tragic series of events: muddled, distressing, filled with a sense of betrayal and hopelessness as well as helplessness. The following is a poignant description of one of our colleague’s farewell:

“Standing in the community hall at Summer Greens on Wednesday felt like a departure lounge, a railway platform, a bus terminus. The difference was that no departures were being announced, no-one knew which door would take you to which place. As I stood there on Wednesday evening with Brighton, Collin, Reginald, Moses and Ellie the sense of what comes next was palpable, but there was also anger and a resignation to fate. Having nowhere to call home does not give others the right to tell you where you should call home without asking you what you need to feel at home, even for a short while. We say it all the time to guests we welcome into our homes “make yourself at home” – has anyone ever said that to the people of SG and the other camps? To me the government response has been one of receiving an unexpected, unwelcome guest – you are not welcome, I am morally obliged to show basic hospitality, but do what you can to make yourself invisible and above all, please don’t stay too long. As we said goodbye we did so without the knowledge of where they were going, something we rarely do, if ever. When was the last time you said goodbye to a loved one or friend without knowing where they were going? As the people leave SG this weekend the only thing I feel I can place my trust in is them. Their resilience up to now has been humbling and at times painful to witness. Bearing witness is what we have all done, and as painful as that has been I have no regrets.” For others of us in the group, it was hard to not completely erase from our minds the whole painful experience, most especially saying goodbye to the children, who could not understand that we would not see them again. We were helpfully reminded by a group member of ‘the breaking of links’ which often occurs in unplanned, premature endings with children. Conclusion There is no ‘final’ stage to this, and the end has not been reached – we do not know if and when this crisis will recur and what we were to do if it did. It is our hope, and possibly an acting-out of an omnipotent rescue fantasy, that we want somehow to share our experience and a way of thinking with the powers and authorities that be, to help create a possibility for a sustained and realistic psychological intervention during a future humanitarian disaster. For us as therapist volunteers, the essence of the experience was perhaps its transitory, unstable nature: this was a crisis into which we were drawn suddenly and with powerful and contradictory feelings, and we continued to be – and to consciously allow ourselves to be - swept along by it throughout the time that the sites were in operation. Ultimately there were no tangible measures of the effectiveness of our intervention. Individual refugees’ whereabouts are currently almost entirely unknown to us, and the sites as such no longer exist. However, the central message that we would like to share about our experience is that Structuring and maintaining a regular, open, supportive, theoretically based-our belief is a psychoanalytic one- communication channel with colleagues during painful and unbearable work processes is the vital step in providing and sustaining such work. It feels appropriate to end with an email which seems to capture the basic tensions inherent in our experience: “The acknowledgement from the men of the importance of the continuity of our presence left me once again confused as to how "so little" could be felt to be so helpful, having left at the end with my usual profound sense of helplessness and pointlessness at being there at all. Two days later I feel clearer about the projective load we carry in this and the importance of working through and

being able to withstand it all. But on Thursday night I felt like I'd come in, borne witness, raised hope or evoked further hopelessness - depending on the point of view of each interaction - and left, a peripheral apparition passing incongruously through the chaos. However, if we offer an experience of not being forgotten about (again, I was told that everyone else who comes is so busy they have no time or patience to talk), and this is attested to, then it feels doubtless important to continue. I also found it tempting to slip into "doing" mode …, while speaking to [one of the men], I offered to contact a friend who's involved in the fire dept.’s volunteer reservists to see if she could find out about employment opportunities. I said I couldn't promise anything, but would try, and will get back to him.” This is the transcript of a talk given on 13 August 2009 to Cape Town Society for Psychoanalytic  Psychotherapy. It is based on a paper published in the August edition of the South African  Journal of Psychoanalytic Psychotherapy.  References Bion. W. (1959). Attacks on Linking. International Journal of Psycho-Analysis, 40, 308-315. Boulanger, G. (2002). The Cost of Survival: Psychoanalysis and adult onset trauma. Contemporary Analysis, 38, 17-44. Garland, (2002). Understanding Trauma: A Psychoanalytical Approach. London: Karnac. Hill,A.& Poss, S.(2009). The Couple As a Microcosm of Society: Some reflections on Reparation in South Africa . Paper given at 30th Anniversary Conference of Johannesburg Psychoanalytic groups. Hobfoll, S., Watson, P., Bell, C., Bryant, R., Brymer, M., Friedman, M.J., Friedman, M., Gersons, B., de Jong, J., Layne, C., Maguen, S., Neria, Y., Norwood, A., Pynoos, R., Reissman, D., Ruzek, J., Shalev, A., Solomon, Z., Steinberg, A. and Ursano, R. (2007). Five Essential Elements of Immediate Empirical Evidence. Psychiatry, 70, 4, 283-315. Klein, M (1958). On the Development of Mental Functioning. International Journal of PsychoAnalysis, 39, 84-90 Kuhn, J. (2008) . Countertransference reactions in Psychotherapy Group Work with HIV Positive Children. Psychoanalytic Psychotherapy in South Africa, 16 (1), 33-60. Morgan, H. (2002). Exploring Racism. Journal of Analytic Psychology, 47, 567-581. Levy, S. & Lemma, A. (2004). The Perversion of Loss: Psychoanalytic Perspectives on Trauma. New York: Brunner-Routledge. Levy, S and Lemma, A. (2006). The Perversion of Loss. Psycho-analytic Psychotherapy in South Africa, 14(1), 46-67. Papadopoulos, R.K. (2002). The Other Other. When the exotic other subjugates the familiar other. Journal of Analytic Psychology, 47, 163-188. Prat, Regine. (2008). You Only See Well if You Use Your Heart. Journal of Infant Observation, 11(3), 307-314. Rustin. M. (2001). The therapist with her back against the wall. Journal of Child Psychotherapy, 27, 3. Tuma, F. (2007). Commentary on “Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence” by Hobfoll, Watson et al. Mass Trauma Intervention: A Case for Integrating Principles of Behavioral Health with Intervention to Restore Physical Safety, Order, and Infrastructure. Psychiatry 70, 4:

358-360 Weisaeth, L., Dyb, G. & Heir, T. (2007). Commentary on “Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence” by Hobfoll, Watson et al. Disaster Medicine and Mental Health: Who, How, When for International and National Disasters. Psychiatry 70, 4: 337-344. Winnicott, D.W. (1955). Metapsychological and clinical aspects of regression within the Psychoanalytical set-up. International Journal of Psycho-Analysis, 36, 16-26.

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