“Of What Might We Speak?” Psychotherapy of a Refugee Survivor of Torture Foster Youth

This paper will examine the complex issues at play in the psychoanalytic psychotherapy of a young Central American survivor of torture seeking asylum in the United States. The treatment of the refugee survivor of torture poses particular challenges to the psychoanalytic process and frame. In addition to the formidable task of rebuilding meaning after unspeakable trauma, both therapist and patient must grapple with numerous questions: How can a safe holding environment be established in the face of the continual threat of termination of treatment and deportation? How can patient and therapist establish a relationship based on trust and the use of speech as a means of psychic repair of unspeakable acts committed in the context of highly disorganized and threatening human relationships in a war-torn country of origin? Can the gap be bridged between the internal and external experiences, culture, and mother tongue of the refugee patient and the therapist? How should the therapist as a representative of the host country navigate the power dynamics and politics of speaking and keeping secrets operating between herself and the refugee seeking access into the United States? How and when should early childhood experiences be integrated into the therapy frame in the aftermath of torture, given that developmental experiences may have played a role in the patient's later exposure to trauma?