Therapists' experiences with patients who had immigrated from the Former Soviet Union.

The current study aims to examine the experiences of mental health therapists working with patients from the former USSR (see comment in Introduction). A review of the literature on this topic, from both Israel and the United States, suggests that most of the therapeutic work focuses on coping with immigration and the acquisition of a new identity, while little attention is given to the therapist-patient relationship. This study aims to broaden the understanding of the therapeutic relationship with patients from the former USSR using qualitative methods.

The study utilized a qualitative - phenomenological approach. We studied the personal experiences and various aspects of the therapeutic relationship, as reported by therapists engaged in therapeutic work with patients from the former USSR. The main research question was "what are the experiences of psychotherapists treating patients from the former USSR".

Semi-structured in-depth interviews were conducted with fourteen therapists who work or have worked with patients from the former USSR in either public or private mental health settings. Eight of these therapists are Russian-speakers from the former USSR, while the remaining six were born in Israel or other countries and do not speak Russian.

The interviews were conducted with the use of the "interview guide" (appendix a) which covers various aspects of the experiences therapists may encounter when treating patients from the former USSR. The interviews were recorded and later transcribed. The interviewees addressed the way in which they perceive patients from the former USSR and the way in which they think their patients perceive them. They also discussed the unique difficulties that characterize the work with this population, their experiences of success and failure with these patients, and issues pertaining to the presence or absence of a common language (Russian) in therapy. Case studies were provided as examples.

Data analysis was conducted in three stages, and seven main themes emerged: 1. Former USSR patients in the eyes of the therapists; 2. Therapy as perceived by former USSR patients; 3. People from the former USSR as patients; 4. The therapists' experiences with patients from the former USSR; 5. What assists therapists in their work with patients from the former USSR; 6. Language; and 7. Trust and mistrust.

The interviewee's origin was accounted for in the data analysis. Some of the themes were similar, regardless of origin, whereas others were significantly different between the two groups of interviewees. As described in the literature, the findings suggest that the main characteristics of patients from the former USSR, as viewed by the therapists, are their status as immigrants, complex cultural identity, familial patterns characterized by multi-generational and single-parent families - more complex than most Israeli families, the high expectations from children, and the intellectual rather than emotional emphasis. The interviewees also indicated a high level of mistrust among these patients, which stems from the totalitarian regime in which they were raised and educated. In this section, the reports of interviewees from the former USSR and those from other origins were not very different.

The findings of the study point to the way in which these perceptions affect the therapeutic relationship and are expressed in difficulties in establishing trust, in the way in which the patients perceive therapy, their expectation from therapy and the therapist, their tendency to see things in a concrete manner and the power of forces from the home to resist the change suggested in therapy. Therapists from the former USSR differed from therapists from other origins in their ability to discuss these issues in the therapeutic session and in their difficulty to endure the unique characteristics of patients from the former USSR. The experiences of therapists from the former USSR were affected by processes of countertransference originating from closeness and resemblance between the experiences of the patients and their own, while the experiences of therapists from other origins were affected by feelings of distance and alienation.

A large part of the Results section addresses the subject of language. The interviewees discussed the meaning they and their patients attribute to the presence or absence of a common language in therapy. The interviewees distinguished between spoken language and emotional language, and mentioned the limited ability of patients from the former USSR to use emotional language. Interviewees from the former USSR talked about the space created by two potential languages in the therapeutic session.

In summary, the current study encourages therapists treating patients from the former USSR to closely observe the processes of cultural transference and countertransference, and the meaning they and their patients attribute to the presence or absence of a common language. On an organizational level, the findings suggest that therapeutic work with patients from the former USSR may take longer and be more difficult for therapists (particularly less experienced therapists) due to their unique characteristics, mainly their difficulties in establishing trust and using emotional language. Thus, it is important to be aware of these issues, especially in public settings, and allow a longer period of time for establishing a relationship while providing the support that therapists may require.