When the World Ceased to Exist, As We Know It: A Russian Therapist’s Experience Working with Ukrainian Refugees

You — My country, hope and sorrow —

    Homeland.

I’m going home,

Let them shout it’s ugly,

But we like it all the same

—DDT (Russian rock group proclaimed illegal in Russian Federation in 2022)

Ukrainian refugees

The Russian Federation’s invasion of Ukraine in February 2022, and the prolonged escalation of the international armed conflict between the two nations, provoked a significant humanitarian crisis resulting in massive displacement of Ukrainian citizens. Most Ukrainians had to move to different parts of the country, where the destruction of civilian infrastructure was not as catastrophic; others fled to neighboring countries, such as Bulgaria, Czech Republic, Hungary, Latvia, Lithuania, Poland, Republic of Moldova, Romania, and Slovakia. An even smaller number of people went to other European countries such as Finland, Norway, Albania, Belgium, France, etc. Even though the conflict involves the Russian Federation and Ukraine, about 3,000 Ukrainians were registered as moving to the Russian Federation (United Nations High Commissioner for Refugees [UNHCR], 2023). The United States so far has welcomed about 2,000 Ukrainian citizens (Statista, 2023). The displaced individuals are mostly women, around 45 years old, with an average per household of 2.4 people.

The 1951 Refugee Convention (UNHCR, n.d.) defines a refugee as “someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion.” The UNHCR reports a majority of Ukrainians (80%) are planning to return home as soon as possible. Approximately 70% have completed college degrees and about 65% were employed or self-employed in Ukraine. Most of the Ukrainian refugees are women since men are not allowed to leave the country due to the mandatory military draft. For the purpose of this article, it is also important to mention that many Ukrainians speak not only Ukrainian but also Russian due to the historical ties between the countries and to family relationships that grew out of the historical and cultural proximity.

Uniting for Ukraine is a program available by the Biden Administration and allows Ukrainians a temporary stay for up to two years. Ukrainian refugees must have a US sponsor who commits to taking full financial responsibility for the duration of their stay in the US. For many Ukrainians and US citizens, it means living with their distant relatives or acquaintances; some supporters are volunteers who responded and welcomed people whom they might have met for the first time in their lives.

Russian family therapist

My first encounter with Ukrainian refugees happened through Jewish Family Services (JFS) of Delaware. While none of the Ukrainians coming to Delaware were Jewish, the organization believes that their mission is to assist any person experiencing displacement. A JFS program manager contacted me asking for my help, as it appeared that I am the only Russian-speaking licensed family therapist in Delaware.

While it was fairly easy to find the statistics describing the overall situation of Ukrainian refugees since the war started, it is much more difficult to describe my sentiments when I think about Russia and Ukraine. While my American friends and relatives are able to take an observer stance, I constantly find myself in the swirl of second-order cybernetics, attempting to live and work in a situation, while constantly questioning myself on what I am living and working through. My personal sentiments and experiences as a Russian person, who grew up in Russia and still has close family and friends there, choosing to adhere to different political views, are constantly interplaying with my personal and professional experiences as a Russian-speaking therapist. I was baptized in Ukraine, had Ukrainian godparents, and grew up in Moscow, the former capital of the Soviet Union, where many nationalities were interacting on a daily basis.

Growing up close to my grandparents, who lived through World War II, I was exposed to many conversations about the horror of living in a war zone or in an occupation. Therefore, war is not an abstract word, but has a specific feeling, smell, and touch. Since the beginning of the war, the thought that any human being is living through a situation of deprivation, fear, and imminent threat of death never left me, pushing me to find ways to be involved in helping the civilian population that has to face the war on a daily basis personally or through their loved ones. While the sentiment of being a “wounded healer” comes up in my personal reflection, I constantly acknowledge that this is not my war, I am not the one who has to make a decision to leave Ukraine or not, I am not the one who is hearing the noise of bombs exploding next to my house, and I am not the one who needs to decide if I am going to run to the bomb shelter. I also live in the US, so I do not have to face the realities of some of my Russian friends and relatives, who have to decide if they are going to stay with a possibility of being drafted to fight for a war that they do not support, or decide to flee, disagreeing with the political regime. Yet, as a person who grew up in both the Soviet Union and post-Soviet Russia, I worry deeply that we have never been so close since probably the 1960s to the possibility of a nuclear conflict.

The work on self-awareness often named in the world of psychotherapy as self-of-the-therapist or person-of-the-therapist is not a new concept (Aponte & Winter, 2013; Bowen, 1978; Nino et al., 2015). It addresses the necessity to acknowledge “therapists are their personalities, subjectivities, life experiences, family-of-origin, social identities, etc. which influence the role they actively take in therapeutic relationship with their clients” (Nino et al., 2015, p. 377 cited in Chen & Hsiung, 2021). Working with Ukrainian refugees provides an opportunity to reflect on who I am today, who I was in the past, and whom I would like to be in the future. While engaging in this introspective work, I cannot agree more with Timm and Blow (1999) who point out that therapists’ personal experiences might impact our clients in positive and negative ways. Moreover, I agree with these authors, who emphasize that rather than looking at self-of-the therapist from a pathologizing, “red flag” perspective, we can see it through a resource-focused lens. That perspective allows me to ask myself how my personal experience with similar situations or how my experience of Soviet culture, offers me an opportunity to be more compassionate with my clients and understand them on a deeper level.

While engaging in this introspective work, I cannot agree more with Timm and Blow (1999) who point out that therapists’ personal experiences might impact our clients in positive and negative ways

Going back to the self-of-the-therapist work, I found it interesting to look at the concept of self from a position of collectivist, rather than individualist norms (Chen & Hsiung, 2021). Remembering that Russia is a Eurasian country, influenced both by Eastern and Western traditions, it is interesting to consider that the concept of “self” from a Russian perspective is much more conformed to collectivist norms, “self in relation to others” (Hardy, 2018 as cited in Chen & Hsiung, 2021), where “our individual goals are considered very much aligned with the expectations and cultural norms of our elders and group harmony and respect for parents … are often valued more than personal choice and freedom” (Chen & Hsiung, 2021, p. 381). Through this lens, I can see how the division of the country, where elders often support the invasion and the younger generation tend to condemn it, influences my own perception and daily experience of the war. The harmony that is usually experienced through the completion of family dreams and fulfilling parental expectations becomes almost impossible in the current political situation.

Therefore, while some authors talk about the “fundamental human longing for our authentic selves to be embraced” (Baima & Sude, 2020, p. 1), I tend to believe that I am mostly longing for all parts of myself to be embraced, which brings me to consider the concept of Intersectionality.

Intersectionality in the context of the Ukrainian War

The concept of intersectionality is attributed to the lawyer Kimberle Crenshaw and describes “how different types of discrimination intersect to oppress people in multiple and simultaneous ways, contributing to social inequality and systemic injustice” (Butler, 2015, p. 584). Since the 1980s, when the concept was first articulated, it was extensively researched, primarily in the framework of power and oppression; however, other researchers emphasized that intersectionality can also be understood as an identity theory, which examines different subject positions and reflective relationship among various aspects of our identity (Nash, 2008). Intersectionality can also include such categories, as class, sexuality, ability, nationality, ethnicity; these categories are also better understood in relational terms, rather than in isolation. “These multiple identities are not summative: rather they create a distinct entity that is subjected to historical and current societal processes of power and oppression” (Gangamma & Shipman, 2017, p. 209). For example, in my case, I am a woman, born and raised in Moscow, Russian-American, first-generation immigrant, daughter of Russian ex-pats, sister of a Russian pilot who lives in Moscow, mother of a Russian-speaking American daughter, which puts me in a position where I could be potentially minoritized, specifically with the current dominant narrative where Russia and by extension Russian people are represented as aggressors. While English is my third language, I do speak it well enough to work and study in the US. I am also married to an American, hold my doctorate degree, and have US citizenship, which puts me in a position of relative power in the US, but also in a position of relative danger in Russia, where foreigners, especially from Europe and the US, are currently seen as enemies. My Russian and American identities often interplay, especially as I work with less privileged communities, such as Ukrainian refugees. They also interconnect as I am speaking to my Russian or American relatives in the context of my work or personal experiences. Being aware of the interplay of these multiple identities, I have an opportunity to process and create resolutions and new narratives (Gutierrez, 2018). I do not feel that I need to choose one identity over another, but rather be mindful of how the interplay between them might potentially connect or disconnect with identities of others.

The concept of intersectionality can also be applied more broadly to the family, institutional, and societal levels to “describe experiences and provide the voice to those on margins” (Seedall et al., 2014, p. 142). In that context, it allows me to question “common sense assumptions,” which have the potential to translate generalist views and contribute to dominant discourses (e.g., poor refugees that need to be saved). It also provides me an opportunity to look at the person not from a position of pity, but from a position of compassion and respect, which brings me to see the person’s resourcefulness and strength.

More recently, and more specifically as applied to refugees, the concept of intersectionality was expanded to include a transnational lens, which acknowledges that people may occupy multiple, often contradictory, locations within the host country and outside of it (Falicov, 2007; Gangamma & Shipman, 2017). For example, while someone might have been in a position of power in their own country, they might have lost that privilege in the host country. Considering transnational intersectionality factors helps me to be more aware of the various factors potentially affecting the mental health of refugees; it also invites me to examine different stressors they might be exposed to in their host country. Finally, it allows me to understand better post-immigration factors that might affect resettlement or a decision to come back home. It allows me to be critical towards “common” refugee-related diagnoses, such as post-traumatic stress disorder, but be more attuned to the contributing factors of cultural differences and the feeling of uncertainty that often accompanies us in a new and uncommon situation.

Our work together

My work with Ukrainian families so far has not been the typical hourly session that I generally engage in as part of my private practice routine. The location, timing, and duration of the session are usually determined by the current situation of the families. The ability to drive is not a given in Ukrainian life: older women often do not drive, and public transportation is very well organized, eliminating the necessity to learn how to drive, unlike the transportation infrastructure in Delaware. Therefore, I would often combine my session with a trip to a store or organize the session in a local park to allow families to have some fresh air and exercise.

During my work in medical family therapy settings, I became acutely aware of the connection between body and mind. You cannot see a person as just “a talking head” without considering all the bodily experiences that each one of us is undergoing in our well or ill state. A person who is facing famine or difficulties with health or living status cannot be fully receptive to emotional and psychological support. While all of the refugees with whom I worked had a designated social worker, some of them reached out to me regarding their health status or daily life questions, as they seem to feel more comfortable due to the fact that contact was already established on a very personal level. It was much easier for a woman to let me know that she needed to see a doctor or ask for a specific item in her newly rented apartment. I would then coordinate with the JFS case manager or found the necessary item.

Keeping in mind the earlier discussion about intersectionality, I have to be mindful not to limit my conversations to pre-immigration experiences of the war. The post-immigration issues often surface and tend to overshadow what happened at home. The families, with whom I had the privilege to work, were from different parts of Ukraine, some from Kyiv (the capital) and some from other big cities. This is important to note, as different parts of the country had more or less destruction and the resources available to those who are living in the capital are often different from other cities and towns, big or small. The social status varied as well. While some were gainfully employed at home, others struggled even before the war started.

The issues that referred them to me varied greatly as well, but were often connected to the difference in cultural and social expectations between sponsors and refugees. These differences pertained to dietary habits, expectations around contribution to chores in the household, daily routines, views on education, and value around money spending. For example, when answering my Miracle Question a 12-year-old Ukrainian girl stated that she would like to have soup for lunch. It is important to clarify that a bowl of soup, like the famous Ukrainian borsch, represents not only comfort food for many Ukrainians, but people from Eastern Europe and Russia also believe that the inability to eat a warm, liquid dish at least once a day can lead to health problems. This answer translated several realities of Ukrainian refugees: limited access to the kitchen and thus inability to cook their own food, fear of sickness as a result of not being able to follow their dietary practices, as well as longing for home, for common smells and tastes.

The social status of Ukrainian refugees is not always clear, since the refugee status is only active for two years in the US. Some Ukrainians are not planning on becoming permanent residents, which makes the adaptation much more difficult. For example, a successful businesswoman from Kyiv, whom we are going to call Anna for the purpose of this article, decided to relocate to the US after another bomb exploded just outside her window. Her mother, father, and husband as well as household pets stayed in Ukraine. Anna came to America with her 12-year-old daughter Olga. From the day of arrival, Anna and Olga knew that they are going to come back home in one year. They framed their trip to the US as an opportunity to learn English. Anna continued her work in Ukraine online and started her English classes through the local University. Olga attended American school and, at the same time, she continued attending her Ukrainian school online. None of them saw their future lives in the US.

Since Anna did not plan to settle in the US, she did not want to acquire a driver’s license or find even a temporary job. Those decisions were met with disbelief and misunderstanding on the part of the sponsor. The more the sponsor insisted on how things should work, the more Anna fought back. Eight months after their arrival, mother and daughter were packing bags to go back home to Ukraine. Anna stated, “I know what to do when the bomb is flying towards my house; I just need to go to the shelter. I do not know what to do when I face cultural misunderstanding in the US. My life is in Ukraine.”

While some Ukrainian families had to leave their settled life at home, others were less fortunate and experienced hardship even before their arrival in the US. The issues that might have arisen at home, such as domestic violence or substance use, continued in the new country of residence. Those struggles often put an already marginalized person under further pressure, since they have to navigate an unknown social and legal system in a language that they don’t understand. In this regard, the case of Ekaterina comes to mind. Ekaterina arrived in the US with her husband and son, welcomed by Ekaterina’s mother-in-law, who was the family sponsor. At home, Ekaterina’s husband suffered from a substance use issue. In addition, the home was often shaken by domestic violence as well as gang violence. Upon arrival, the husband was in recovery, however, the violence pattern remained. One day, when the husband hit Ekaterina again, she decided to leave the home for good. Ekaterina does not speak English and holds a low-income job. With the help of JFS, she was able to secure a new apartment and find a lawyer to start the divorce process. Needless to say, Ekaterina will need continuous support not only to get used to her new way of living, but also to address the ongoing family dynamics with her husband, mother-in-law, and son, and I will be there to assist as I can.

As I connected to Ukrainian families on language and cultural commonalities, it was interesting to observe that we often saw each other being in a mentor-mentee relationship or social acquaintance rather than a therapeutic relationship. I was their guide in a world that they were trying to explore and navigate and in the process, a tender link was created that helped them to survive and adapt. I cannot say that it was a specific therapeutic approach that helped Ukrainian families that I encountered, rather a soulful exchange that led all of us to feel grateful for a genuine presence that would still give hope that love will overcome everything, even the war.