Enemy in the consulting room: The impact of terrorism and armed struggle on the course of therapy of Palestinian Arabs with an Israeli Jewish analyst

When patient and therapist belong to two opposing ethnic groups that are engaged in war and terror, anonymity, neutrality, and indeed psychotherapy itself become almost impossible. Primitive transferences that involve suspicion and hostility are mobilized from the very beginning, and sadomasochistic power struggles threaten the therapeutic alliance at all times. Case vignettes from the treatment of three Palestinians by an Israeli analyst illustrate how developmental traumas may be reenacted in the relationship with an "enemy" therapist. From the therapist's perspective, this relationship may necessitate considerable technical flexibility, as well as a willingness and a capacity to tolerate and contain paranoid, hateful, and sometimes murderous feelings within the therapeutic dyad. From the patient's perspective, this involves the difficult task of trusting the enemy. It is virtually impossible to disentangle the personal from the political under conditions of national conflict, and their overlap may contribute to the development of extreme cultural attitudes to terrorism. Against this backdrop, the choice of an "enemy" therapist may reflect patterns of deeply ambivalent object relations, and may offer an opportunity to work through them as both parties oscillate between hate and hope.