This is a story about a young mental health professional who, during her internship at a municipal psychiatric clinic, introduced a social-political dimension to the clinic’s work.

The story comes from a USAID-funded course for Israeli and Palestinian Mental Health Professionals as Change Advocates, conducted in 2008-09 at the School for Peace at Neve Shalom / Wahat al Salam. Some of the training addressed the option of including, within the treatment framework, social and political content and dynamics connected with the Israeli-Palestinian conflict – especially when the treatment relationship crosses national boundaries (a Jewish therapist with an Arab client, or the reverse). Several lectures during the course, and a lot of reading material, were devoted to this subject and the facilitators addressed it.

Most approaches to psychotherapy take the opposite position – that such material has no place in the therapeutic framework. Dealing with this content is traditionally viewed as interfering with the intra-psychic therapeutic process. The present story illustrates the sort of intervention that graduates of the School for Peace Change Advocates course have been initiating.

Not only did this particular psychology student introduce this kind of material in her sessions with clients; she also brought it to staff meetings at the clinic where she works – despite her hesitation at speaking out when she is only an intern. The clinic is located in a “mixed (Jewish-Arab) city” in the north of Israel and has many Arab clients and well as Jewish clients – yet there is no Arab therapist on the staff. The story is presented here in the first person, as she recorded it:

No Arabs on the staff

“In the clinic where I am doing my internship, there are about 30 Arab clients (including Muslims, Christians and Druses). The clinic does not have a single Arab therapist. The senior staff members say that in the past, they tried to integrate an Arab therapist into the team, but were unsuccessful – mainly because the Arab clients requested a Jewish therapist.

“I am working with four young Arab women clients now. Their particular needs are not addressed in the supervision I am receiving, nor are they addressed in the clinic staff meetings. During the recent Gaza war, a lot of material came up that involved the conflict, my Jewish identity, and the Arab identity of my clients; that the staff did not address this at all was very conspicuous and even began to make me angry. I went to the clinic director and spoke about the need to address this in staff forums. A few other staff members made the same request. The director was responsive, which was encouraging.

“Before the next staff meeting, I was asked by two other therapists to present some cases from my therapy sessions. I was instructed not to relate to the political dimension, but only to the psychological characteristics of these clients: How much capacity do they have for self-scrutiny? How possible is it to talk with them about feelings and emotions? And so forth.

“The instruction to ignore the political dimension really bothered me. The will to discuss only the purely psychological aspects felt like a kind of denial; it seemed so superficial. I was unsure about how to deal with this, given my very junior position.

I decided to speak up for what I believe in

“In the end, I decided to speak up for what I believe in. At the staff meeting, I began with what felt like ‘coming out of the closet’ and talked about my involvement in these issues [of Israeli-Palestinian relations] and my participation in the Change Advocates course at Neve Shalom. I told about two of my clients and discussed the theoretical basis of treatment for each. I mentioned the writings of psychologist Nissim Avissar,* who argues that the imperative to deal with political content is “the last taboo” of psychology.

“I talked about a treatment session I did during the war, when the client arrived and said that she wanted to leave therapy, for various reasons. She did not relate to the war but she showed up with a keffiyeh around her neck. My invitation to deal with her Arab identity and to the reality on the outside enabled her, in the end, to continue with the therapy and to allow a lot of significant content to come up. The other case I discussed involved an article in the literature on the development of “black identity.” I cited an example from therapy with a young woman who was dealing with questions of identity. In that case I introduced for her the possibility of seeing in such questions, not only issues involving her personal history, but also issues involving her national affiliation.”

For a thorough discussion by Avissar of these issues, see, e.g.: “PsychoActivism – past, present and future: Examining the Israeli-Palestinian case,” by Nissim Avissar, M.A. in Clinical Psychology M.A. in Hermeneutics and Cultural Studies, Sheba Medical Center, Bar-Ilan University (undated).

Dr. Avisar is a graduate of the 2006 change agents course.

“Advocates for Change: Israelis and Palestinians Mental Health professionals in Dialogue and Action” was made possible with the generous support of USAID and the American People in cooperation with the School for Peace at Neve Shalom/Wahat al-Salam and Hewar Center for Peace and Development.