Bosnia Postwar: 
“Don’t just do something, sit there!”
Nina Thomas, PhD, CGP

Maybe it’s my American “pragmatism” in conflict with my “therapist self,” but in my trips to Bosnia, I frequently found myself repeating the group therapy dictum: “don’t just do something, sit there.” The refrain repeated so often in my head that I lost track of how it actually went. Its relentless and unbidden repetition ran often through my mind the training groups I conducted for mental health workers in Bosnia. It caught me in the moments I wanted to "fix" the massive disruption, both psychological and social, faced daily by the people I had come to work beside. 

Wanting to do something is what propelled me to go to Bosnia, after seeing too many images of war and flight that filled newspapers and television. Up close and personal, however, it was difficult to envision what I could do. Thus I often struggled with a sense of helplessness, wondering if anything I might do could possibly make a difference. At the same time, I had a deep wish to do something. It quickly became evident that that was exactly what my Bosnian colleagues struggled with also. In the face of the traumatizing effects of war, it was difficult to trust that listening was a powerful action to take.

I traveled to Bosnia in mid-August 1999 to provide workshops and seminars for mental health workers, psychologist-pedagogues (equivalent to American educational psychologists) and social workers, under the auspices of Catholic Relief Services (CRS). CRS is one of the few non-governmental organizations (NGOs) providing psychosocial services in the region. They invited me to return to do work similar to what I had done two years before; that is to train mental health workers to provide a broader and deeper range of interventions and to develop a team of multi-disciplinary professionals. (I had also traveled to Bosnia in 1997, a little more than a year after the Dayton Accords had been signed.) I provided workshops in group therapy, working with dysfunctional families, and divorce.

The Effects of War
Bosnia, once a stable multi-ethnic society, has been torn apart by the war as well as by its aftermath. Divorce, once unheard of, has increased so markedly as to affect almost all cases seen by mental health workers and counselors. Added to the immediate postwar effects are the massive changes occurring as a new governmental entity is formed and privatization of the economy takes place. Many questions with deep repercussions for the provision of services remain unanswered. For example, how will mental health services be funded? What services will be private and which public? 

Bosnia has also experienced a major population shift. Some two million people either became refugees abroad or were displaced within their own country. Families were expelled from areas they had lived in for many years and separated from one another by fighting or emigration. The large shifts in population have isolated people from the social support networks that had been the mainstay of their lives. It was not uncommon for a wounded soldier, usually a man, to have been evacuated to a Western country for medical treatment that was unavailable in Bosnia. If he were lucky, his immediate family (wife and children) were evacuated with him, often on very short notice (an hour's notice was not unusual). While their material lives may be substantially better than if they had remained within Bosnia, the loss of family and social supports has long-term, profound impacts both on the evacuees and on those family members who remain behind.

In other instances, people have experienced loss due to the death of close family members. In addition, demobilized soldiers returning to families, many of which had been dispersed throughout more than 120 countries during the war, experienced unemployment and little prospect of finding jobs. (When I was in Bosnia in 1997, the unemployment rate stood at 75 percent. Today the statistics are somewhat difficult to gather and are variously reported as between 40 and 65 percent.) Separated from their husbands by war, women's social roles were significantly changed. They were thrust into positions of responsibility and independence. Their reunion with husbands now unable to provide economically for their families makes the restoration of family life problematic. 

The Outside Expert
The Bosnian mental health professionals responsible for addressing the traumatic effects of war and its sequelae often lack the training to deal with the magnitude of the problems their clients face. They are themselves traumatized by their own and their families' experiences of war and survival. The primary objective of the project for which I was invited to work was to increase the competence and skill of local professionals who face the extraordinary challenge of meeting the mental health needs of the communities they serve. 

The utilization of foreign experts in international relief work is an issue fraught with political implications. One concern relates to cultural attunement when non-national experts are involved. Another consideration is the length of time a foreign expert is available to work on a project. Most NGOs operating in conflict areas require a minimum commitment of six months from a volunteer to justify the expense involved. During the war in Bosnia, many experts were described as "parachuting" in, doing their "turn," and disappearing, never to be heard from again. I was repeatedly aware as I faced various discomforts or inconveniences that I was free to leave. My Bosnian colleagues were not. 

What I Offered
The training I offered was conducted in groups utilizing both experiential and demonstration groups as part of the process. (In this and other instances, my years of attending AGPA and regional Institutes and Conferences provided me with an invaluable framework to draw on.) It was arduous, indeed exhausting, to give nine workshops—three different subjects to three different groups of 35 members—in less than three weeks. Simultaneous translation added to my fatigue. Ordinarily I would depend on a sense of informality and humor to lighten the sessions, but translated jokes can fall incredibly flat. I was grateful for my translator who would regularly signal that a joke was coming by shifting her tone to a subdued chortle heralding the soon to arrive piece of humor. It was a little more difficult to assess how subtle psychological concepts were being communicated. On occasion, I needed to check that ideas like "transference," "identified patient," or "triangulation" were understood as I intended them. This often led to a hasty series of negotiations over the choice of word and explanations of psychological ideas.

I taught group therapy, family therapy, and the impact of divorce and re-marriage on children and families. Participants were invited to join a demonstration group; they either took the role of their patients or enacted the roles of a family and its therapist. By working with the group I not only modeled a group process but also was able to develop the group's identity as a team that could rely on its own strengths long after I left. 

For one session I utilized a fairly standard “ice breaker” technique as a way of beginning the group experience, asking participants to take turns “interviewing” the person seated next to them. The instruction was that they try to learn something about each other that they did not already know, after which they would introduce their “neighbor” to the group. (Many members of the group either worked together or had studied together or in some way had a relationship preceding the workshops.) Not surprisingly, participants offered fairly “safe” personal data. There was one significant exception. 

One of the last people to speak was a man who had come late to the group, after introductions were already begun. Therefore, there was no one to partner with him. When it came his turn I made clear what we were doing and asked if he would introduce himself and share something about himself that others in the group did not already know about him. He was a supervisor of some of the participants in the group, a senior administrative person in one of the clinics. By way of introduction he said about himself that during the war his only son, 23 years old, had been killed. Not a day went by, he said, that he does not think of his son and of his death.

The very personal material shared by this man was striking in several aspects. First, most Bosnians behave very formally in their dealings with one another. Thus, they rarely share such personal information. Second, Bosnian society is hierarchically organized so that a supervisor typically maintains his authority by maintaining his distance from his subordinates. To offer himself as one among many, as much like the clients we were discussing as his fellow workshop participants, was especially noteworthy. His doing so made it possible for other participants to share their own refugee experiences and their own losses that so paralleled those of the people with whom they worked.

Though many of the participants had previous experience in role playing, they had limited experience with experiential training. They were much more familiar with formally structured learning that flows from an identified "expert." Eager to develop their competency, however, they participated with gusto in their roles as their most difficult patients. They did this well, somewhat more cautiously though movingly, in the experiential aspects of the training. 

They tested me profoundly by the complexity and difficulty of the cases they presented for consultation. I was challenged to establish my credibility. The question of my credibility revolved around whether I could understand the difficulty of the situations they faced, the trauma of their own and their clients' lives, and the degree of despair and destitution for both client and clinician. The implicit, underlying questions were: Could I understand what it means to work in a system that is being re-invented around them? And what did I know of loss, of suffering, or of privation? 

What seems to have been the most powerful resource I brought with me was my willingness to listen, my capacity to identify with their suffering, and most of all, to bear witness to the lives they have and are enduring. The group therapist’s dilemma: “don’t just do something, sit there” remains for me as a haunting challenge to the activist in me who thinks: “don’t just sit there, do something.” Despite the occasional discomforts and inconveniences, working with people in Bosnia was deeply enriching.

Nina Thomas, PhD, CGP, is a Supervisor in the relational orientation at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis and Senior Supervisor and Teaching Faculty at the Contemporary Center for Advanced Psychoanalytic Studies in Livingston, New Jersey.

This article was published in the August/September 2000 issue of The Group Circle.