Ethically Treating PTSD Resulting from Terrorism and other Traumas

Now, let's look at the importance of psychological anchors and transference regarding the mutual fate bond. As you know, the experience of being a hostage does not end with the resolution of the situation. As with PTSD, many hostages relive the experience through daily psychological anxiety and sleepless nights. Studies ascertain how potential hostages might better cope with the experience of being in captivity.

Psychological Anchors
One of the greatest difficulties with any alien situation is the inability to find the psychological anchors that we all require in order to deal with life. Uncertainty is most difficult in an anxiety-ridden circumstance. The degree of anxiety produced in such situations is said to be so great that even situations that produce clear cut negative expectations are perceived as being easier to manage than uncertain situations with a more positive outcome.

The captive can anticipate and understand what his captors are doing and what is likely to follow. To the extent that this is possible and that the process is reinforced by the hostage having made accurate predictions, the level of uncertainty, disorientation, and anxiety is sharply reduced. It is also important for the individual to make some mental link to the outside world.

♦ Transference of the Mutual Fate Bond
Let’s look once again at transference from the point of view of time in captivity and a mutual fate bond that develops.

The perception that time is on the side of the negotiators is based on the psychological concept of transference. As you know transference is a mental process through which a sense of closeness and attachment develops between the hostage and his captor. As time wears on, both captive and captor find themselves locked in a mutual fate. The captive feels powerless before the captor, thus he or she begins to identify with him, and perceives that his hopes for survival reside with the captor. The captor is seen as having the opportunity to offer life to the captive - if only the authorities will agree to the captor’s demands.

The fact that the captive has been put by the captor in a situation where the captive’s life has become a commodity of exchange interestingly enough is ignored. It is no longer the captor, but the negotiators who are perceived to be standing in the way of survival and responsible for the prospect of death.

♦ Not Asymmetrical
The transference process is not necessarily asymmetrical. A similar bond can be created between the captor and the hostage. The impact of sharing physical space under conditions of mutual crisis and stress build intimacy and an emotional bond that generally serves as a proactive measure against the hostage being killed. The strength of this bond is said to increase with time. In fact, it is commonly said among those experienced with hostage negotiations that if a hostage is not killed during the first fifteen minutes of an episode, the odds are that he will not be killed.

There is yet another reason why time is perceived to be on the side of the negotiators. As the situation progresses and the prospect of imminent death continues, all but suicidally-inclined captors desire some way out of the situation. Also, as time wears on, the police can rotate personnel. The hostage takers, unless well equipped, trained, and in significant numbers, will find that their capacity to act decisively and think clearly will erode with time.

However, the process of transference is not simply a function of time. It is also dependent on the nature of the interaction between hostage taker and hostage. All things being equal, the longer the period of time in which the interaction between hostage and captor takes place, the greater the degree of transference. However, if the interaction is hostile, transference will generally not take place.

Transference during Skyjacking
When treating a PTSD client, the professional Code of Ethics states to respect the client’s self-determination. However, in this next case study ask yourself, is there a question in your mind regarding the actions of the passengers on this skyjacked plane? Interviews conducted by the FBI with passengers on a Trans World Airlines flight skyjacked to Paris graphically illustrate the relationship between transference and the quality of interaction between hostage and terrorist.

One of the skyjackers was described as abusive, arrogant, and threatening. He had a habit of continually touching the phony dynamite brought on board in such a fashion as to add to the passengers’ anxieties. As a result of these threatening actions, individuals who had substantial contact with him did not experience transference.

In direct contrast, the feelings of the passengers toward a female skyjacker, who was warm and outgoing while she played hostess to the passengers, were very positive. She was referred to by some of the passengers as “the perfect hostess.” Another one of the skyjackers was also warm and positive in his reactions to the passengers who had contact with him.

♦ Predetermined Hostilities
However, transference will generally not take place when there are predetermined racial or ethnic hostilities between captive and captor. Israeli officials indicated that there has not been one instance of transference by an Israeli hostage toward an Arab captor. Transference will also be precluded when the hostage is capable of maintaining some intellectual distance, which enables the objective assessment of one’s plight as having been used by one’s captors.

Objective Assessment
Here’s an example of objective assessment. Once again note this incident took place prior to September 11th, which will become evident as the story unfolds. Richard Brockman, a 29-year-old psychiatric resident at New York’s Columbia Presbyterian Hospital, was aboard the ill-fated TWA Flight 355 when the terrorists seized it. In an article titled, “Notes While Being Hijacked,” he detailed his response to thirty terrifying hours on board the flight. At the conclusion of the episode, the intercom blared and Brockman recalled:

“This is the captain speaking.” His voice is clean, no cracks. “We have all been through an incredible experience. But it is over for us. No one is hurt. However, it is not over for our hijackers. Their ordeal is just beginning. They have a cause. They are brave, committed people. Idealistic dedicated people. Like the people who helped to shape our country. They are trying to do the same for theirs. I think we should all give them a hand.”

Dr. Brockman writes the hijackers are smiling. The audience is applauding. Quite a shocking story given recent events.

For Dr. Brockman, even in the surge of relief, he could not develop the emotional affinity for the hijackers that many of the other passengers did. To the end, he was distant and objective, aware that his life had been negotiated for some higher objective in which he was only a participant as an accident of circumstance.

4 Transference Variables

♦ In summary, it appears from case by case observations that a number of variables enter into determining whether transference will take place:
(1) the length of time the hostage and captors are confined;
(2) the quality of the interaction - were the hostages well treated?;
(3) the existence of predetermined racial or ethnic hostilities between hostage and captor;
(4) the predisposition on the part of some hostages to seek out and relate to their captors.

Of course, one of the most publicized episodes of transference by a hostage to her captors is that demonstrated by newspaper heiress Patricia Hearst, who not only took a lover from among her captors but also provided them with covering gunfire when they were about to be seized for shoplifting. Patricia Hearst’s behavior was different only in degree from what is commonly observed in hostages under long-term stress. And if Patricia Hearst’s responses were more extreme, it is also true that the conditions of her captivity, both in terms of the severity of deprivation and duration, were also extreme. These factors were probably exacerbated by her age and lack of experience.

Here’s an ethical point for you to ponder, regarding these case studies of transference, if you have experienced a loss due to an act of terrorism: What do you feel you need to do if you treat clients who experience a positive transference towards a terrorist? Would you consider referring the client to another therapist?
Reviewed 2023

Peer-Reviewed Journal Article References:
Carsky, M. (2020). How treatment arrangements enhance transference analysis in transference-focused psychotherapy. Psychoanalytic Psychology. Advance online publication. 

Glad, K. A., Hafstad, G. S., Jensen, T. K., & Dyb, G. (2017). A longitudinal study of psychological distress and exposure to trauma reminders after terrorism. Psychological Trauma: Theory, Research, Practice, and Policy, 9(Suppl 1), 145–152. 

Himmerich, S. J., Ellis, R. A., & Orcutt, H. K. (2020). Application of PTSD alcohol expectancy symptom clusters to the four-dimensional model of PTSD: Support from moderations of the association between symptoms of posttraumatic stress and alcohol use. Psychological Trauma: Theory, Research, Practice, and Policy, 12(4), 347–355.

Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141.

Kaufman, J. S., Allbaugh, L. J., & Wright, M. O. (2018). Relational wellbeing following traumatic interpersonal events and challenges to core beliefs. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 103–111.

Levy, K. N., & Scala, J. W. (2012). Transference, transference interpretations, and transference-focused psychotherapies. Psychotherapy, 49(3), 391–403. 

Online Continuing Education QUESTION 8: What four variables enter into determining whether transference between hostage and captors will take place? To select and enter your answer go to CE Test.