HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Michaila ChondrokoukiPsychologist (MSc, DPsych), Psychotherapist

Keywords: abuse, grief, meaning making, adolescence, institutional context, reflective process, therapist's internal dialogue


"Man cannot sprout wings unless he has first reached the brink of the abyss"

Nikos Kazantzakis (1955). Last temptation

I will narrate the story of a teenage girl, Iro, with whom I was working therapeutically for about two and a half years, once a week, in a community therapeutic unit for children and adolescents. For the past few years, Iro has been living in a residential care home. Drawing notions and meanings from systemic and psychoanalytic thinking, I attempt to capture snapshots of our therapeutic journey. In my narrative, I will be turning the lens from the larger system to the smaller one and vice versa, in an attempt to connect the "inside" with the "outside", the macro- with the micro-level, to understand the relationship of the parts with the whole and the relationships of each system with its context. I hope that this will shed some light on the dynamics and network of intertwining contexts and systems within which Iro's difficulties developed.

The context

According to the systems approach, family is a dynamic system, a network in which members interact with each other (Belsky, 1981), shaping behaviours and cultivating values. Let us consider what happens in alternative forms of accommodation, such as institutions or residential care contexts.

One of the main declared goals of the institutional framework is to provide protection and meet the needs of the children it hosts, to offer a "home", to assume, that is, the role and responsibilities of the parent - the "good enough parent" - so that the child can unfold their feelings, imagination and thinking. However, due both to practical (e.g. lack of staff) and institutional issues as well as due to the prevailing institutional culture, there is, following Pluymaekers' line of thought (as cited in Charalampaki, 2020), a conflict between the official and the unofficial program, the explicit and implicit message, between what is proclaimed and what is actually done.

Children raised in institutions do not have the opportunity to develop stable bonds with a permanent caregiver and experience frequent changes of carers. At the same time, the departure of caregivers is a common phenomenon and it is something that can be perceived as an institutional or systemic enactment, an unconscious mental movement of the parts of the system. Therefore, one could say that children in institutional care are subject to "structural neglect" (Van Ijzendoorn, 2008, p. 148). Children need their own space and objects, both physically and mentally. This is by definition unattainable in residential care settings, where there are physical limitations of space, as well as absence of privacy, of exclusive dyadic relationships and of tailored individualized care. As stated by Bowen (1978), the group of children in child protection settings becomes an "undifferentiated ego mass".

Given the above, the system, being unable to provide what a child needs emotionally, focuses on providing material goods and covering practical or survival needs, thus resulting in offering mechanistic, perfunctory care. This, however, seems to serve mental functions as well. It helps the caregiver to endure the unbearable mental reality, which the family could not contain, that ultimately resulted in the child being moved into residential care.

Lighting the family portrait

"We are unable to understand a melody if we listen separately to each tone."

Knauss (2006, p. 159)

Iro is 16 years old, grew up with her mother Janet and her stepfather Kostas in Athens, and since she was 13.5 years old, she has been hosted in child protection. Iro was removed from the family environment when she reported her stepfather for repeated attempts to molest her. Her mother died suddenly at the age of 43, just a few months before Iro's complaint, and there was no other close relative who could take care of her. Iro had revealed to her mother what was happening, and as she said "we kicked him out of the house, but because he promised it wouldn't happen again, we took him back in".

Iro depicts her mother as an active, dynamic super woman, protective and a good mother, while their relationship is presented through her narratives quite idealized. Some of Iros' phrases demonstrate the intensity and nature of their bond: "we were inseparable", "the psychic umbilical cord will never be cut", "she was everything for me, my friend, my mother, my support", "we read each other's thoughts, we spoke with our eyes".

Her mother was born and raised in Romania in a strict and abusive environment. From a very young age, she had to prepare food for her family of four and do the housework, which resulted in the neglect of her own needs, the deprivation of a carefree childhood and her poor, disrupted school attendance. If she disobeyed the rules, her father used severe verbal and physical violence against her, often resorting to extreme behaviour. Janet came to Greece in search of a better life, cutting off ties with both her parents and her brother. Iro never met the maternal family.

In Greece, Janet formed a relationship with Petros, a Bulgarian man, with whom she became pregnant with Iro. The mother broke off the relationship when she discovered that he secretly had another family at the same time. Petros did not acknowledge Iro as his own child. He was murdered, due to possible involvement in illegal activities, when Iro was an infant. Iro expresses strong feelings of disgust and anger towards her biological father. Later, Janet met Kostas, a Greek man older than her, in a shop where she worked. They soon got married and Kostas willingly recognized Iro as his own child. Kostas has a history of two marriages and five children, with whom he does not maintain close contact. He declared that Iro was his "favourite" child. Iro mentions that Kostas and her mother were a loving couple and that she doesn't remember them ever arguing. Due to professional commitments, Kostas was regularly absent for long periods on trips both in Greece and abroad. Janet worked occasionally. The family's support network was limited to a few friends, and Janet and Iro lived relatively socially isolated. The parents informed Iro that Kostas was not her biological father at the age of 10. Iro has met three of her half-siblings, without, however, maintaining ties.

Kostas was molesting Iro since she was 11. He would go to her bed at night when her mother was sleeping. Iro hardly mentions the relationship with her stepfather, which is described as ideal up until the abuse. She wonders "why" her stepfather would do such a thing. From experiencing this trauma of betrayal (Altmaier, 2019), Iro's trust in people has been shaken and socializing with men has been uncomfortable for her. Many times, when she walks alone on the street, she is overwhelmed with the fear that someone is following her and might hurt her, and feels panicked and helpless.

Referral - Request

Ιro was referred to the therapeutic unit by her caregivers shortly after her transition to the residential care setting because they noticed "inappropriate affect" and "significant detachment from feelings of pain and grief about what has happened". In the first months following her mother's death, Iro developed a depressed mood, as well as sleeping and eating problems. Caregivers were also concerned about Iros' self-harming behaviours (cutting her hands), as well as her difficulty adapting to the care home, trusting and relating to peers. Iro was open to starting psychotherapy, as she experienced her emotions as overwhelming and recognized some of her difficulties.

Holdings and sources (or wounds) of power

Iro describes her faith as an inexhaustible source of strength for her that keeps her going through difficult times. She believes that her mother found inner peace through religion, and for this reason, she believed deeply in herself. Religion has been an important point of reference and connection with her mother, especially after her mother’s death.

Iro is a highly intelligent girl with excellent academic performance, strong motivation, creativity and a variety of interests, including sports and music. Her academic achievements and praise by her teachers contribute to a positive self-image and belief in her abilities. However, her high and often unrealistic expectations, as well as the fear of failure, overwhelm her with anxiety and pressure, which sometimes manifest through her body in the form of psychosomatic symptoms (e.g. skin) or sleep problems.The learning process and the frustrations it entails threaten her fragile ego and shake her delusion of omnipotence. "I must do everything perfectly. Mother had big plans for me", are Iro’s thoughts that echo her mother's internalized voice. She must serve these expectations, whatever the cost may be, otherwise, she feels she is betraying her mother.

At the care home, Iro is especially loved by the caregivers, who invest in her abilities and, like the maternal figure, have high expectations of her, in a way that sometimes leaves no room for her more fragile or vulnerable sides to unfold. Thus, the "false self" Iro had to recruit in order to adapt to the needs of the environment is maintained.

Iro is interested in public affairs and has a vision for a better world. Her ideology of freedom, democratic values, justice that condemns all forms of oppression, violation and power, seems to be the antidote to her wounds, her way to defend what was undermined in her family, and treat her invisible wounds. Perhaps, it is less painful for her to be angry at society, the setting that accommodates her, the child protection system, and life, than to turn the spotlight on her family drama.

Assumptions, thoughts, and creating meaning

The formation of provisional – and subject to questioning - assumptions is a process, in which there is a constant back and forth in the therapist's internal dialogue between the position of "knowing" and "not knowing". This process can also be perceived as a polyphony of heterogeneous voices (Bakhtin, 1981). In the context of my interaction with Iro, the following hypotheses emerged, always ensuring, as Anderson and Goolishian (1988) suggest, that the "conversation" is "open" to alternative readings and stories.

In Iro's family, there are no distinct boundaries or sufficient personal psychic space for the members. The spousal subsystem appears to be dysfunctional and not differentiated from that of the children, which is reflected in the merged mother-daughter relationship. As Bowen (1978) pointed out, a high degree of fusion in the relationship involves a loss of self. Iro is triangulated. She fills the void of the physical and emotional absence of her father, by taking on some functions of a marital or parental role. She sleeps with the mother, shares everything with her, listens to her problems and enters, one might say, into an"eroticized" relationship with her.

The family is characterized by strictness and rigidity as far as their rules and moral code are concerned. The mother exercised punitive discipline, sometimes resorting to violent and dangerous behaviours, which were viewed by the system as a form of care that has educational value. It has been shown that one way in which traumatized mothers transmit their own trauma to their children is through harsh behaviours, such as verbal and physical violence (Kim, 2009; Schwerdtfeger et al., 2013).

Iro was "trained" to have her antennae tuned towards the needs of her overburdened mother, carrying her own emotional burdens. The parental role she was inevitably adopting at times created in her an inflated sense of responsibility and a pervasive sense of guilt. The likelihood that the child will "be parentified" by undertaking a supportive-caregiving role toward the parent increases when the parents' emotional needs are unmet (Byng-Hall, 2002). The unresolved issues, emotional deficits, and unfinished business of previous generations are passed on to the child and plague them. Through this process, parents project their immaturity onto their children (Bowen, 1978), by transmitting family stress to them, while at the same time shaping children's level of differentiation (Zervanos, 2009).

Iro's mother had been emotionally cut off from her family of origin. What was Janet's relationship with her own mother like? Why did she cut off all ties with her brother too? What buried secrets have never been revealed? Not only did Janet experience a harsh childhood of deprivation and violence, but as it turns out, she did not even seem to have had the ability to narrate her story coherently so that her experience could be organized in some way. Iro seems to feel her mother's pain without, however, being able to give it meaning and content.

Iro's experiences in her primary relationships hindered the formation of a stable sense of self. Rejection by her biological father, the trauma of abuse, and ruptures in the relationship with her parents imbued her existence with a sense of fragility and defined the way she related to herself and others. Her parents projected their fears, phantasies, unfulfilled desires and emotions on Iro. In order to fortify herself and ensure a degree of autonomy in the undifferentiated family she grew up with, she developed mechanisms such as withdrawal, self-sufficiency, food control (through deprivation restrictions), very strict criteria and perfectionistic tendencies.

In Iro's family, there are contradictory and confusing messages in communication. On the one hand, there are very strict boundaries and rules and, on the other hand, there is a violation of personal boundaries. The explicit message does not chime with the unspoken. Actions do not match words. "I trust you completely but I forbid you to disagree, to have a voice". In addition, the child becomes the receiver of double messages and witnesses a pseudo-reciprocity (Wynne, Ryckoff and Hirsch, 1958), a contradictory reality where the parents seemingly "love each other", but emotional closeness and authenticity are absent. The family lives under the illusion that there is consonance and understanding between the parents when in reality they struggle with feelings of emptiness and meaninglessness.

The system seems to conspire to maintain its homeostasis. Janet's "blindness" is possibly motivated by her unconscious refusal to see the sexual assault against Iro, and perhaps reflects a deep fear of abandonment, a terror of the loss of self-delusion, of the truth and what it might bring to the surface. Iro kept the family together by keeping the secret about the sexual abuse by her stepfather sealed inside her. What unconscious alliances had mother and daughter formed in order to maintain the homeostasis of the system until Iro decided to break the silence and speak? Even the decision to evict the father from the house was undone, since the force that pushed them to commit to the invisible debt of loyalty and devotion to the family won out, and they eventually returned to the former condition in a short period of time. Through self-harm, Iro seems to turn the violence she has suffered against herself. Thus, she creates a relationship with herself and her body that she is able to control, without the mediation of the other.

The rushing river of lamentation

"My mother, how I miss you now that suffocating, deep darkness will become in my futile life that everything fades... Ah, how I miss you at such a time".

Maria Polydouri (1929). Echo over chaos

Bereavement is the amalgamation of emotional responses and manifestations following the loss of a person with whom we had a close emotional bond (Stroebe et al., 2001). The violent severing of the bond with her mother that came with her death marked out the mental world of Iro, who felt her life shattering. "I lost mom, I lost everything, myself". Since her mother was a point of self-definition, following her loss, Iro experiences a disruption of her sense of self-organization, her self-narrative and identity are undermined, the aspects of mourning that have been studied by Neimeyer (2000, 2006). The loss of the mother is accompanied by the threat of loss of emotions, the loss of self and the fear of mental breakdown, annihilation, non-existence.

To endure the pain of loss, the person cuts off from reality, thoughts, memories and feelings (Gušić et al., 2016). Iro often stated "I don't feel anything at all", expressing her disconnection from experience and the suspension of mental processing. At other times, she was comforted by the thought that "Mom has become an angel in Heaven". In the early stages of treatment, Iro often fantasized of being with her mother and wished to die so that they could be reunited. Iros’ crying for the sudden death of her mother - that occurred in front of her eyes - and their premature, unexpected separation was inconsolable. Iro mentioned that they had sworn to each other that they would never separate, but due to the death of the mother, they broke that vow. She felt that her life had no longer meaning. She zealously preserves the legacy left to her by her mother, which is the values ​​and principles she instilled in her, such as being strong and not afraid, not letting others take advantage of her, being independent and excellent in everything she does.

"If I am what I have, and if what I have is lost, who then am I?"

Erich Fromm (1976). To have or to be.

The therapeutic process

My first impression of Iro was that of a beautiful, intelligent, nice girl, who wanted to get help and had a developed ability to put her feelings and thoughts into words.

In the early stages of therapy, she expressed her anger about the painful changes she experienced between her mother's death and her removal from the family environment and the transition into the residential care setting. She condemned herself for her decision to report her stepfather for the abuse. She blamed the residential staff for the perfunctory/undifferentiated care they provided and the "lack of caring". She struggled to adapt to the new lifestyle, and at first faced issues with peers who made fun of her. She usually responded with a sense of arrogance and contempt, disavowing her genuine feelings. In relationships with friends or boyfriends, she sometimes gave up her own desires to maintain closeness with them, while other times she sacrificed her need for closeness and care and entered relationships in a self-reliant and controlling manner. Remaining loyal to the "unwritten law" her mother established, Iro does not express vulnerable feelings. It seems that the survival mechanisms that the mother developed as a child were incorporated into her interactive kaleidoscope and bequeathed to Iro.

Iro expressed nostalgia for the "old life", as she called it. She missed her previous school, her old classmates, her home, and especially her mother. She had the need to idealize the mother and her previous life. Her family is 'good' and the residential care staff are 'bad', as the residential setting itself reminded her of the insufficiency or inadequacy of her own family. The defense mechanism of splitting blocked the integration of good and bad and did not give "permission" to her ambivalence to express itself. She also talked about how traumatic her participation in the hearing process was as well as her stay at the Children’s Hospital before she was transferred to care. The issue of sexual violation remained securely "locked" inside her. Iro brought to our meetings her wounded, empty self, the lack of meaning and desire for life. She was deeply disappointed, experienced betrayal and death, and began to be deprived of every life-giving power, such as food, care, and pleasure. Sometimes the trauma would be expressed through silence, and other times it would make deafening noise.

The language used by Iro revealed aspects of the roles she had been assigned in the family as well as her hidden emotions. She was apologizing to me for no reason as if she was afraid of being judged or punished. Her speech, full of "shoulds" and self-criticism, demonstrated a strict code of ethics. I often mirrored the language she used, which helped her recognize how familiar the feeling of guilt was to her and how polarized her thinking was. What tormented her for a long time in psychotherapy was that she may have been responsible for her mother's death. "A few hours before she died, we had a fight. Maybe she had the heart attack because of me".

During psychotherapy, she mourned the painful losses she experienced. Not just the death of the mother. She also mourned the loss of the phantasy of the "ideal" family and her childhood. She mourned all that she had and lost and all that she did not receive as a child. She was deeply hurt when her illusion of a wonderful childhood and a caring, nurturing environment began to crumble. She was becoming more capable of looking away from the internal distorting mirror through which she used to view her family.

Only after enough space was given to Iro to grieve, long, and feel the pain, did memories of her mother being cruel, merciless and violent emerge. Her mother used to beat her brutally and humiliate her on trivial occasions. To cope with the overwhelming burden of this realization, Iro resorted to intellectualisation, by rationalizing the mother's behaviours or blaming herself. "She did everything out of love", "I was to blame for pushing her to the limits". Iro's profound guilt, as shown in the course of psychotherapy, censored any expression of anger towards her mother or stepfather. After all, if she turns against herself, if she becomes "bad" (too), then the "other" does not seem as bad. She prefers, therefore, to shoulder the burden of responsibility for the abuse she suffered so that the idealized parental image does not collapse. Thus, she maintains the illusion of good and the hope that things can change. Fairbairn (1952) referred to this function of the child as a "moral defence against evil objects". I remember her guilt-ridden words when she was thinking of her stepfather in prison. "I shouldn't have done this to him. Deep down he didn't want it. I ruined everything by talking".

Gradually, she found the courage to move from anger to pain. She overcame the demon of shame and began to talk about the betrayal, fear, anger, the loathing but also the tender feelings she had towards her stepfather, for which she felt confused and guilty. After a number of sessions where Iro untangled the issue of sexual violation, she entered the therapy room, was silent for a while, looking at the toys around her and said: "Today, I have the desire to play. Can I?" It was the first time she expressed this desire. She sat on the floor in front of the dollhouse, set up the furniture, and represented a family of four (dad-mom-daughter-son) in everyday moments. At night while they are all sleeping, a burglar breaks into the house, steals money and belongings, and kidnaps the daughter. As soon as the parents realize what has happened, they call the police who finally arrest the perpetrator and the daughter is rescued.

I wondered about the meaning of the story and about Iro's choice to play at this point in the therapeutic journey. Is this a regression to an earlier stage? Has she been able to reconnect with the child part of herself that was repressed? Does she avoid talking? I did not know exactly what was going on... But I sensed that something important was happening. Had she chosen an in-between, transitional space in order to metabolize, process, and heal her wounds and parts of her experience for which there were no words? In the play, she could project and process phantasies and anxiety in a symbolic way that allowed her to take a safe distance. She seemed relieved to have found a place to say what had not yet been said, or what had no way of being said. Although I wasn't participating in her play -sensing that she wanted me to be a silent observer - I felt that we were attuned in an unspoken, silent, analogue way.

Shortly after the first year of psychotherapy, Iro decided to visit her mother's grave for the first time after the funeral and left her a letter telling her how she was feeling. She also wrote a letter to her stepfather but could not send it to him in prison. "It was liberating just to write them down", she said. Thus, she began to write, creating a vital space for her inner voices that had been silenced, and gradually her critical voice was giving way to her self-compassionate voice. She was able to acquire new ways of viewing reality. The image of the mother was enriched, which allowed her to renegotiate her relationships.

By demystifying the mother, Iro was becoming more able to listen to and express her own needs without censorship, to understand and reflect on her mental states. She developed the ability to recognize her own and others' thoughts, feelings, motivations, and behaviour, which is described by Fonagy and Bateman (2008) as the ability to "mentalize". Iro is going through a phase of searching for identity and self-definition, being open to discovering and defining her personal coordinates. She negotiates the balance between the desire for closeness and the desire for individualisation. She tries to find the right distance between not allowing herself to be violated and not isolating herself in her individual cell out of fear of others. This process, I think, is summed up in Winnicott's phrase that the "eternal task of man" is to "remain distinct yet connected".

The therapeutic setting, providing the stability, predictability, and holding that Iro probably needed, seems to have enabled her to express and allow previously conflicted parts of herself to cohabitate within her without struggle. She managed to make new meanings, to forgive, to integrate the old with the new, to unravel implicit meanings and construct new ones, building a more coherent, integrated self. Now, Iro can look back on the past, recognizing her true feelings and being aware of the dark parts of her personal history, placing responsibility back where it belongs. Emotional differentiation allowed her to unhook to some extent from the shackles of the past. After all, as Winnicott (1953) says, "acceptance of reality is never complete".

The therapist's internal dialogue

From the very first meeting, Ιro elicited in me strong feelings and a desire to take care of her. In our initial meetings, and even though I felt quite overwhelmed, I had a feeling of hope (or I just expected a lot from Iro too) seeing her potential and courage. I admired her strength in making the decision to report the sexual harassment by her stepfather while she had no support. Accordingly, Iro entered our relationship with expectations that filled me with anxiety about whether or not they could be fulfilled.

There were many moments when I was torn between my trust in the process and my fear that we would get lost somewhere along the way. For this reason, I noticed what was happening between us, focused on what was happening inside me - not always so easily - and tried to keep the "internal dialogue" between myself and my role open (Rober, 1999). I was trying to observe and make sense of the phenomenon of resonance and how it works so that I could utilise it in service of Iro. Many times, I felt that our histories were intersecting at some points. I felt a responsibility to be aware of my emotional reactions and – to the extent possible – to set my own values ​​and prejudices aside, as well as to recognize the inevitable power imbalance in the therapeutic system. In the words of Adler (1931, p. 72), it is crucial to be able to "see with [the client's] eyes and hear with his ears".

A recurring feeling, I had while working with Iro was that as soon as we took one step forward, we took two steps back, as if an invisible force was resisting. I was startled and frightened by the distance Iro would suddenly take, and the way she would withdraw from me or cut herself off from her emotional experience. Even though I felt there were moments of profound connection between us, where there was a two-way flow 'like electricity flowing' from one to the other (MacLeod, 2009, p.42), Iro sometimes seemed to need to fortify herself behind a protective wall. We tried to give voice and make sense of the conflicting parts of Iro; the part that wants to erase the past and move on, the part of her that wants to protect her mother or father, the part that experiences fear destructively, the part that hopes.

At times, the projective identification was so intense that it took me considerable time, reflection, and introspection to realize the position I had entered. My thoughts and feelings felt so fragmented, and I was experiencing a kind of paralysis, a pervasive, undefined anxiety. In retrospect, and after it was translated into thought and language, this experience of mine, made it easier for me to feel Iro’s early and difficult emotions. I had the image of a baby feeling overwhelmed by distressing emotions, and a mother being unable to unify its disjointed pieces and metabolise them for her.

In relation to psychotherapy, Iro mentioned that it was helpful but that she would find it more beneficial if I told her what to do and gave her advice. I listened to her request and explained my position that such a thing would not help her own development and empowerment. In a way, she was asking me to become her mother. This would be a repetition of that enmeshment and would hinder Iro’s differentiation. I often felt she was calling me to take on the role of her domineering and controlling mother. I had to consciously resist this. However, I sometimes found myself becoming directive, which is not consistent with my usual therapeutic stance. As alert as I was, there were moments when I unconsciously entered into the dance of re-enactments of the dysfunctional relational patterns that existed in Iro's life.

I remember very vividly, how cold, dismissive and distant she was when she came back after a planned therapy break of a few weeks. She expressed her anger that I was not there during the difficult moments she had during the break. The absence, the phantasy of loss (or death), and the fear that I would forget her filled her with anger and anxiety. She told me that no one really cares about her, neither her carers, nor me. "You're just doing your job. After all, you psychologists are trained to not be affected by the clients and listen to them without letting anything get inside you". In the therapeutic system, there were pervasive feelings of sadness, fear, anger, disappointment. When I mirrored the frustration and fear she was feeling, understanding how painful what she perceived as "unavailability" was for her, she began to cry non-stop as if something that was looking for an outlet had escaped from her. Once she calmed down, she explained she got emotional because she felt accepted and cared for. This experience filled her with relief and sadness at the same time.

It was one of the ruptures in our relationship that opened the way to work directly in the "here and now" of the therapeutic relationship, deepening our connection and facilitating the emergence of Iro’s core issues. Rupture repair opened an authentic dialogue that welcomes the unwelcome and embraces the inevitability of failure in relationships. Iro now realizes that allowing her vulnerable parts to find their place and voice is a strength and not a weakness. We are two vulnerable people who travel together, and sometimes we wander like meteors on unknown paths, with the commitment to think, understand, make as much meaning as we can and tolerate.

As Anderson and Goolishian (1988) aptly stated, "understanding is always an active, ongoing process, and never fully achieved" (p. 378). Change in therapy comes through the unfolding dialogue and emotional attunement between therapist and client (Seikkula and Trimble, 2005). This new co-constructed reality acts as a container of intrapsychic and interpersonal conflicts that allows buried emotions to surface and trauma to be relived in a protected context so that integration is achieved. It was evident in the therapeutic work with Iro that the reflective function together with the new relational experience had a restorative and transformative power.


In a time when the collective trauma of the pandemic, the attack on bonds, the loss of all forms of certainty, the reminder of mortality, the increasing familiarity with "distant" operation make up our external reality, it is paradoxical and at the same time exciting to live moments of closeness, turn shackles into bonds, create connections and meanings - perhaps our strongest bulwark against the onslaught of the "unnatural". Ultimately, crises may force us to discover and reconstruct new realities.

Iro turned adversity into opportunities for change, for mental growth. She became the author of her story, producing a more coherent and flowing narrative. She chose to keep her moral map, albeit, enriching and revising it. She was able to say goodbye to the hope/wish for a better past. The silenced discourse became an articulated discourse and, along the way, an expanded dialogue. Iro stopped harming herself, formed some close friendships, and realized that there are options in her life.

The end of the therapeutic process activated in Iro previous losses, and separation/abandonment anxiety, but also included a feeling of gratitude. When Iro first expressed her thoughts about ending psychotherapy, I doubted whether this was the right time, I thought about Iro's voices that had not yet been articulated or truths she had not come to terms with, and I wondered "why now?". What was my difficulty in letting her go about? I turned the lens inwards. Through my personal reflection and observation, what might have been triggered within myself began to become clearer to me. Once again, I was confronted with the finitude of human limits, but also the countless possibilities that open up through connection with the other. Even if there are dark, impassable paths, she may not be able or willing to walk them yet. She has the freedom to choose. Filled with hope, I contemplate that it is great that Iro can say goodbye, take responsibility for setting her own boundaries, decide not to be the adopted child she had learned to be anymore. Some seeds were planted in this healing journey, which by nature is designed to come to an end at some point. What kind of seeds, when and how they will flourish remains unknown. One of the many "unknowns" the therapist must endure.

It is an enriching experience for me to accompany children and adolescents on their journey of integration, self-determination and growth. I feel grateful for having had the opportunity to be Iro's fellow traveler on this journey and vibrate with her, discover and wander unidentified areas of myself, and get in touch with my own vulnerability and limitations.

Even if we get to the end, the story doesn't stop here. The process continues. Every ending, every death makes room for something else to begin, to be born...

"What we call the beginning is often the end

And to make and end is to make a beginning.

The end is where we start from...

....We shall not cease from exploration

And the end of all our exploring

Will be to arrive where we started

And know the place for the first time".

T.S Eliot (1942). Little Gidding


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ARTICLE 8/ ISSUE 21, October 2022


Nikos Marketos, Psychiatrist – Systemic Psychotherapist
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