When Therapy Happens During War

When Olena speaks about her son, she says little about the past or about how he came to be a prisoner in Russia. Vadim, 19, was seized as a civilian at a checkpoint in the Donbas, in territory occupied by Russian forces at the start of the full-scale invasion four years ago.

What occupies Olena now is not how it happened but what may come next. Her concern centers on how four years of captivity may have changed him and whether she will know how to speak with him when the time comes for him to be released and returned home.

Such fears are common among families of detainees and former prisoners of war. Trauma does not end with release. For many, the most psychologically demanding period begins afterward, when reality is different from long-held expectations.

Olena is one of many Ukrainians participating in live psychotherapy sessions as the war continues. The patient-therapist conversations are not recollections shaped by distance or hindsight. They take place while missiles still fall, while loved ones remain missing, and while the threat itself has not passed.

Therapy While Trauma Is Active

Source: Mitzi Perdue Photo

The sessions are led by Viktor Dlugunovych, a Ukrainian-American psychotherapist who specializes in trauma. Participants include civilians whose lives were abruptly overtaken by war: mothers, widows, displaced people, and families living with prolonged uncertainty.

In one session, Olena was asked a deceptively simple question: How did the occupation begin? She described explosions, a destroyed bridge, the closure of her workplace, and the sudden realization that her daily routines were gone.

As often happens in trauma-focused therapy, the conversation with Olena quickly moved away from external events and toward their internal consequences.

Anticipating the Reunion

Olena’s greatest fear centers on reunion. She worries that ordinary conversation might trigger her son. She wonders how to speak without reopening wounds. She is deeply afraid of saying the wrong thing and continuously rehearses scenarios of what she might say to him when they reunite.

Dlugunovych did not offer scripts or reassurance. Instead, he emphasized something many trauma survivors find difficult to accept: There is no way to prepare perfectly.

He reminded her that it would be not only her son who had changed. She, too, had changed. Their country had changed. Their relationship would not resume where it left off. It would need to be rebuilt.

He pointed out that she could not anticipate every outcome and that, in his experience, the kind of vigilance and mental rehearsal she described often lead to exhaustion and paralysis. Rather than rehearse scenarios, he encouraged her to learn how to live with uncertainty.

Instead of planning what to say, he advised her, plan for flexibility. He reassured her that her maternal instincts were likely to be a more reliable guide than any script she could prepare in advance.

Guilt as a Second Injury

As the session continued, another source of pain emerged: guilt.

Olena blamed herself for her son’s capture because she had not gone with him when he attempted to flee. She replayed that decision repeatedly, imagining alternative outcomes. Dlugunovych told her that she's not alone in having such thoughts. This form of guilt, he told her, is pervasive among parents in war zones and often persists long after a child is no longer in danger.

He emphasized that there was no way she could know what would have happened had she gone with him. “It could easily have been far worse,” he told her. “The responsibility for what happened to Vadim lies with those who took him prisoner, not with you for failing to foresee it.”

Dlugunovych is familiar with research showing that unresolved guilt increases the likelihood of depression and anxiety. Part of his work in the sessions involves allowing Olena to realize that the responsibility for what happened to Vadim isn't hers; it lands squarely on the shoulders of those who took him captive.

When Caregiving Collapses the Caregiver

The discussion led Olena to speak about her late husband.

“In all the decades of our marriage,” she recalled, “I only once saw my husband cry, and that was when his mother died. But after Vadim was taken prisoner, he would turn away from me at night so I would not see that he was crying. He blamed himself relentlessly.”

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Her husband died of heart failure just months after Vadim’s capture. In Dlugunovych’s view, self-blame combined with sustained stress was a major contributing factor.

“Caregivers are often among the most vulnerable casualties of war trauma,” he said. “Parents and spouses frequently internalize responsibility they cannot resolve. Without support, that burden can become devastating.”

Strength Follows Action

As the session drew to a close, Dlugunovych offered a final principle: “Confidence does not precede action. It follows it.”

He has observed that many people believe they must feel strong before they can act. Instead, he encouraged Olena not to wait for strength or confidence to appear. “Do one concrete thing, however small,” he told her. “Volunteering, creating art, or even telling your story to a journalist proves to yourself that you already have strength.”

The War that Continues

The sessions offer a rare view of trauma while it is still unfolding. Russia's War on Ukraine is not just a map of moving battle fronts or casualty counts. It is also the war that takes place inside a person. This war is one that is likely to continue long after the guns, drones, and rockets stop.