The translated article below is by Vladislav Synyagovsky – psychiatrist, psychotherapist, military psychologist at the EXPIO clinic in Kiev – and a colleague in the Ukrainian Clean Community. He describes the recovery of a Ukrainian soldier who had been repeatedly traumatised as a prisoner of war. We have highlighted the part played by Clean Language and Symbolic Modelling.
The original article in Ukrainian is at: blogs.pravda.com.ua/authors/synyagovsky/685e5a54c54bf/
“I didn’t know that anything alive was still inside me. But after the fourth session, I saw my true self – and understood that not all was lost.”
– Andriy, Ukrainian war veteran and former POW.
In my practice, I’ve witnessed many harrowing stories. I have personally conducted numerous tactical and psychological debriefings with those released from captivity, held over 300 combat debriefings in units of the Armed Forces of Ukraine, participated in reintegration programs post-exchange, and received specialised training at the National Defense University on a reintegration and post-isolation support program. But this case is special because of its critical severity. Severe depression always carries a high suicide risk.
A veteran who endured more than two months in captivity by “Wagnerites” came to the EXPIO clinic. He was captured near Bakhmut at the end of 2023, wounded after a brutal battle in which almost all his comrades died; he suffered both concussion and grenade injuries.
At the moment of capture, they attempted to execute him on the spot. He was severely beaten, tortured physically and psychologically throughout the captivity, threatened with execution, and deprived of food and sleep.
He arrived at our clinic after extensive medical treatment and work with a psychologist, yet remained in a severe depressive state: barely spoke, would only utter short phrases, had no desire to live, was exhausted, broken, deeply isolated. His body was traumatised. His psyche was in a constant state of defence. Deep sleep, human trust, memory, joy of life — everything erased or hidden behind a defensive mask shaped by wartime survival behaviour. This was precisely the kind of case we are told about in psychiatry departments — a personality collapse, as if “frozen” inside: emotionally, physically, spiritually — almost unreachable.
Such severe depression often ends tragically. In general, captivity by the ‘orcs’ causes deep personality changes that are hard to reverse.
Our team was faced with a challenging case. We all understood that clearly. We chose a combined approach: psychiatry, psychedelic medicine, and modern psychotherapeutic interventions.
Treatment Plan
Our individually tailored treatment plan was based on the severe consequences of torture and mental exhaustion. It included:
1. Short-term sedation
2. EMDR (Eye Movement Desensitization and Reprocessing)
3. Medication with antidepressants
4. Preparatory psychotherapy for Ketamine-Assisted Therapy (KAT)*
5. Several sessions of KAT
6. Integrative metaphorical psychotherapy using Clean Language and Symbolic Modelling
* Ketamine was administered in sub-anesthetic doses under controlled conditions. It opened access to deep, blocked experiences and imagery.
During the preparatory stage, using EMDR, we “reconstructed and relived” the memory of the day of captivity — including capture, transport, first interrogation, torture in the “water glass,” and other traumatic details — in a safe therapeutic environment.
Next came Clean Language: which opened up a world of metaphors, symbols, and internal images, enabling the patient to engage with them safely without being re-traumatised. Through symbolic representation of bodily pain (in colours and shapes), focusing on his feelings, grounding with breathing (mindfulness), existential searches for meaning, discussing problems, goals, and pathways to recovery — he gradually regained the ability to feel, live, and speak.
Group therapeutic work helped crack the internal “armour” the veteran carried from his torture in captivity. Memories, emotions, and images appeared — and together we walked the path toward integration of the trauma.
Results & future outlook
The result: he came back!
After two and a half months, we saw a person who not only survived – but began to live. He began to speak, returned to his beloved, reconnected with people, started writing his memoirs — and most importantly, wanted to live. Now he participates in veteran programs and dreams of helping others who have lost themselves in the darkness of captivity.
At our final meeting he told me:
“This was more than treatment — it was a rebirth. I don’t know how you did it, but I’m here again. And I exist.”
Why I am sharing this
Because there will be many more such stories. We must be ready for them — not only as a state, but as a medical community and as a society. Treating PTSD, severe post-captivity depression, and complex trauma is a challenge for which we now have the tools. They exist in Ukraine — and they work. Military psychologists and psychiatrists from the entire civilised world are learning from us. Just yesterday I spoke with the creators of the Montreal model of ketamine-assisted therapy, which we have already integrated and supplemented with our approach.
And this is not just a medical case. It is the story of one of thousands of our Heroes returning home having endured captivity under the most extreme conditions, preserving dignity and love for their Motherland. We must be grateful for their sacrifice.
The state and big business must contribute to funding such assistance.
Vladyslav Synyagovsky, 27 June 2025
Psychiatrist, psychotherapist, military psychologist, EXPIO Center
