Shared Trauma

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Shared TraumaCarol Tosone ab; Martha Lee a; Lisa Bialkin a; Alexandra Martinez a; Marisa Campbell a; Maria MercedesMartinez a; Mychelle Charters a; Jennifer Milich a; Kathy Gieri a; Adrienne Riofrio a; Stacey Gross a; LauraRosenblatt a; Christine Grounds a; Jennifer Sandler a; Karen Johnson a; Maria Scali a; Denise Kitson a; MiriamSpiro a; Shane Lanzo a; Aimee Stefan a

a New York University School of Social Work, USA b National Academy of Practice in Social Work,

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To cite this Article Tosone, Carol, Lee, Martha, Bialkin, Lisa, Martinez, Alexandra, Campbell, Marisa, Martinez, Maria Mercedes,Charters, Mychelle, Milich, Jennifer, Gieri, Kathy, Riofrio, Adrienne, Gross, Stacey, Rosenblatt, Laura, Grounds, Christine, Sandler,Jennifer, Johnson, Karen, Scali, Maria, Kitson, Denise, Spiro, Miriam, Lanzo, Shane and Stefan, Aimee(2003)'SharedTrauma',Psychoanalytic Social Work,10:1,57 — 77

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Martha LeeAlexandra MartinezMaria Mercedes MartinezJennifer MilichAdrienne RiofrioLaura RosenblattJennifer SandlerMaria ScaliMiriam SpiroAimee Stefan

Shared Trauma:Group Reflections

on the September 11th Disaster

ABSTRACT. This article describes the unique collective reflections ofM.S.W. students enrolled in the senior author’s “Clinical Practice withGroups” course when the September 11th tragedy occurred. The instruc-tor and many of the students, due to the proximity of the school to the di-saster site, were first-hand witnesses to the event. The article addressesthe student clinicians’ initial reactions to the tragedy, as well as their laterrealizations that their personal and professional lives would be perma-nently altered by the experience. The unusual opportunity for growth and

Carol Tosone, PhD, is Associate Professor, New York University School of SocialWork and Distinguished Scholar, National Academy of Practice in Social Work. LisaBialkin, Marisa Campbell, Mychelle Charters, Kathy Gieri, Stacey Gross, ChristineGrounds, Karen Johnson, Denise Kitson, Shane Lanzo, Martha Lee, Alexandra Marti-nez, Maria Mercedes Martinez, Jennifer Milich, Adrienne Riofrio, Laura Rosenblatt,Jennifer Sandler, Maria Scali, Miriam Spiro, and Aimee Stefan are recent graduates ofNew York University School of Social Work.

The authors would like to thank Lisa Bialkin for her expert editorial assistance inthe preparation of this article.

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2003 by The Haworth Press, Inc. All rights reserved.10.1300/J032v10n01_06 57

Carol TosoneLisa BialkinMarisa CampbellMychelle ChartersKathy GieriStacey GrossChristine GroundsKaren JohnsonDenise KitsonShane Lanzo

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the implications for clinical practice are also considered in the context ofprofessional literature on the topic of secondary trauma. [Article copiesavailable for a fee from The Haworth Document Delivery Service:1-800-HAWORTH. E-mail address: <[email protected]> Website:<http://www.HaworthPress.com> © 2003 by The Haworth Press, Inc. All rights re-served.]

KEYWORDS. September 11th, secondary trauma, shared trauma, masstrauma, disaster

INTRODUCTION

“You can talk or you can cry, but you can’t do both,” reflected one of thegraduate students at New York University’s Ehrenkranz School of SocialWork when asked to discuss her feelings and reactions to the terrorist attackson the World Trade Center. The difficulty involved in confronting and ex-pressing painful personal emotions is but one of the challenges faced by virtu-ally everyone in New York City as a result of the traumatic events ofSeptember 11th. That challenge is even greater for mental health professionalsin general, and clinical social workers in particular, who face the added com-plexity of working in a profession that requires them to help others addresswhatever personal issues were evoked for them as a result of these events. Howwe, as clinical social workers, are able to deal with the unique situation of con-fronting our own feelings evoked as a result of the tragedy at the same time astreat patients who are in the midst of experiencing many of the same feelingsand difficulties as their caregivers is the focus of this paper.

The ideas presented here are the collected reflections of the social work stu-dents, all women, who were scheduled to meet for the first class of ProfessorCarol Tosone’s Clinical Work with Groups on the morning of September 11that 11 a.m., directly after the attacks. As the members of the class soon discov-ered, there seemed to be no better way to learn how to do clinical work withgroups than to actually work as a group to process the events that were fore-most on everyone’s minds. In the first part of this paper, these social work stu-dents who, in one year, will enter the field as clinicians, give voice to theirinitial reactions to the tragic events. The second part of the paper explores theevolution and development of these initial reactions over the ensuing twomonths, as the students attempted to make sense of their feelings and emotionsfrom the perspective of greater distance, time, and available resources. The fi-nal part of the paper demonstrates that the ability of clinicians to work with pa-tients in the highly unusual situation in which caregivers and patients are

58 PSYCHOANALYTIC SOCIAL WORK


simultaneously confronting many of the same issues relating to trauma de-pends as much on the clinicians’ abilities to process their own personal reac-tions to the events as on their dedication to the needs of their patients–in muchthe same way that the individual experiences of members in a therapy groupare fundamental to the group process as a whole. In this context, unlike the re-flection that began this paper, talking and crying are not only able to coexistbut must be seen as inseparable.

GROUP’S EARLY REACTIONS TO A SHARED TRAUMA

The students’ early reactions, within the first month of the disaster, encom-passed an enormous range of intense personal emotions, including denial,shock, disbelief, bewilderment, fear, anxiety, hysteria, sadness, sorrow, de-pression, hopelessness, sleeplessness, confusion, forgetfulness, distractedness,uncertainty, helplessness, anger, relief, thankfulness, guilt, hope, defiance,love, liberation, and a renewed desire to find meaning in life. Reactions alsodiffered with respect to the perceived impact of the terrorist attacks on clinicalpractice, ranging from increased desensitization and lack of empathy towardpatients; difficulties in helping others when preoccupied with personal feel-ings; increased feelings of insecurity, uselessness, and helplessness with re-spect to clinical abilities, on the one hand, to increased feelings of empathy andconnection to patients, a greater need to feel involved and to communicate, anda newfound sense of confidence in professional competence on the other. Andif there is a common theme to be drawn from these early reactions, which thispaper will explore, it is that in the context of trauma, and particularly of theevents of September 11th, how a clinical therapist best responds to the needs ofpatients in connection with the trauma experienced by all of us is inextricablyinterwoven with how these events have been personally interpreted and re-sponded to, which in turn is dependent on how earlier events have been inter-nalized and responded to. As stated by Fullerton, McCaughey and Ursano(1994, p. 5), “[T]he psychological responses of individuals to trauma varygreatly. The meaning of any traumatic event is a complex interaction of theevent itself and the individual’s past, present, and expected future, as well asbiological givens and social context.”

Some of the students’ most common early personal reactions included ini-tial shock, numbness, and disbelief, followed by denial and in some cases de-tachment, often despite the graphic news reports that no one could escape.“Even with pictures of the burning tower in front of me, I still couldn’t believewhat I saw,” wrote one student. Others described in detail the great lengths towhich they went in order to deny the reality of what happened, including run-

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ning seemingly senseless errands, attending to “more hysterical” friends, andtrying to distance themselves by intellectualizing the events. “Essentially, Ispent the initial hours of the disaster avoiding fear by taking care of the peoplearound me,” wrote one student.

Many students described initial feelings of bewilderment, confusion, andhelplessness. “I was confused. . . . The carpet was pulled from under me. I be-came frustrated. . . frustrated with my placement, frustrated with my supervi-sor and frustrated thinking my life was ruined,” wrote one woman. Still othersdescribed how they were not even sure how to react, often basing their ownfeelings on the reactions of those closest to them and the comparisons that theycould then draw. A sense of feeling alone was also prevalent, in particular forthose who were not involved in love relationships at that time. Many studentsdescribed a preoccupation with world events and an inability to stay focusedand concentrate on day-to-day matters, both as students and practitioners, aswell as a lack of motivation, distractedness, forgetfulness, and sleeplessness,often accompanied by nightmares.

Numerous papers described the overwhelming feelings of sadness, sorrow,grief, and pain that followed these first reactions, alternating with feelings ofloss, of being lost, and a general sense of hopelessness. “Immediately follow-ing the tragedy, I was overcome by sadness. I felt depressed,” wrote one stu-dent. Another wrote, “I don’t worry about my personal safety much, onlyabout the safety of those I love. Mostly I worry about the evil in the world mychildren will inherit. In spite of my optimistic nature, it is hard to see a rain-bow.” For many, depression set in; for some, this feeling has remained.

No less prevalent was anxiety, and in many cases, ongoing and acute fearrevolving around feelings of insecurity about personal safety, as well as an in-creased need for reassurance from others: “Fear seemed to creep up on mefrom every angle, whether it was being startled awake by a plane flying thatseemed too closely overhead, worrying about the packages I saw in the sub-way, or simply jumping two feet off my chair because a book banged to thefloor from another student’s desk.” Others described more dramatic reactions:“I did not see that I would ever feel better, and therefore, could not perceiveany other person ever feeling better than I felt every moment since Sept. 11th.”Wrote another woman, “my initial thoughts the evening of September 11thwere that I would probably die within the week.”

For many the world had suddenly become unbearably unpredictable. “I feltas though one of my basic needs of feeling secure in New York City, which Ihad felt prior to these events, was suddenly gone and replaced by fear,” notedone student. “I have never experienced a state of anxiousness as constant andoverwhelming within my personal and professional life,” and “I was scared ina general kind of way” were other reactions. Fears of commuting, and of sub-



ways in particular, worries about being in large public places, and nightmaresand disturbing images, both real and imagined, were frequently conjured up: “Icannot stop the scenarios in my head of an explosion leaving me trapped in adark tunnel for a week until my final rescue is death,” wrote another student.The desire to protect loved ones alternated with the desire to be protected. Asthe mother of a three-year child wrote, “I felt scared and powerless and wasafraid I wouldn’t be able to protect my daughter in this new world. . . . Sincethat day, every day, I often feel I need her more than she needs me.”

Anger, rage, and even hate at the turn of events and the persons who causedthem were also described at great length: “Disbelief soon gave way to anger atthe people who had perpetrated this carnage, sorrow for those who had lostloved ones, as well as an unfamiliar feeling of pride at being part of a citywhose dwellers were showing such unbelievable courage.” One youngwoman’s emotions were raw and palpable. “My rage peaked at the UnionSquare rallies,” she wrote. “I could not tolerate peaceniks when all I wantedwas revenge, decapitations, the bloodiest possible vengeance on the perpetra-tors and their cohorts. Surgical, precise, minimum civilian loss, but no mercy,no prisoners, certainly not turning the other cheek. My rage and intolerance ofthese blind and misguided mounts. My blood is boiling. I want someone liter-ally to come at me so I could beat them into a pulp. I am also angry at anyonewho continues to believe in God. There is nobody home. Don’t you get it?”

Many students expressed concern that life as they knew it had been irrevo-cably changed. The following excerpts reflect a common feeling that “nothingmakes sense as before, nothing will be as before,” as well as a desire to try “toget back to a normal life” in a world where “nothing felt normal”:

Perhaps the most unsettling thought to me is the knowledge that life haspermanently changed. I doubt that I will ever feel the same nonchalancethat I did in the past when boarding a plane, taking a trip abroad, ridingthe subway, or opening my mail.

Every so often I think I am getting on with my life and I find I’ve beencaught downward of the burning World Trade Center, miles away, theacrid smell a visceral reminder of September 11 and of how different ourworld is now.

The concept of moving forward seems almost impossible; it is extremelydifficult, for what we once considered normal, will never be again.

This shocking tragedy has forever changed our thoughts and feelingsabout safety, freedom, and reality. As a result, our once reasonable andvalid theories apply no longer.

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Spurts of sadness and an attempt at normal alternates in my heart and inmy life. Nothing makes sense as before, nothing will be as before.

Still other personal reactions to the tragic events included relief and thank-fulness that they and their loved ones were not among the victims, feelings thatwere often accompanied by punishing feelings of guilt regarding their owngood fortune, as well as their ability to carry on their lives as usual and in thisway to “forget.” One student wrote, “the second tower is hit and reality weighsme down. I look back at this day now and think . . . people were dying, chaosoccurring, and I was snoozing, ignoring.” For some, these intense feelings ofguilt and shame expanded to include the ideas that they themselves should nolonger be allowed to feel good, that they are not deserving of anything “nice”in their lives as a result of their “privilege,” and that any problems they facemust be viewed as insignificant in the context of what had happened. “I felt weshould do something, but there was nothing to do. I felt like I was bad for nottrying harder to find some way to help,” one woman expressed. “I felt selfish,self-absorbed, and self-centered,” stated another. “I was alive and nobody Iknew had been injured. Who was I to complain for feeling uncomfortable?”asked one student who had to move out of her apartment, which was locatednear the World Trade Center. “How could I possibly be focusing on my ownissues when so many others are experiencing such real pain?”

Competing with these distressed reactions, however, were a number ofmore optimistic ones, including the development of a new sense of perspec-tive, a forced questioning of themselves, and therefore an unusual opportunityfor growth. Other feelings included an increased desire to look for meaning ina life that had a new sense of urgency. The need–even compulsion–to “dosomething” was overwhelming for many students and had both positive andnegative overtones. “My need to help someone, to get involved, to overcomemy feelings of impotence was very strong, almost selfish,” articulated one stu-dent. Many discussed their “need to be needed.” As one student observed ofherself, “I needed so badly to feel of use, to feel that at least I had a purpose in atragedy that seemed so pointless, so purposeless.” Another reflected, “All Iwanted to do was lose myself in something–anything–to escape my own feel-ings of powerlessness and uncertainty.”

Some members of the group expressed a new sense of strength, defiance,and even hope. “I have no answers, only hope,” one student observed. For oth-ers, this hope was mingled with sadness: “There are moments when I dance tothe rhythm of salsa in my kitchen but sorrow and sadness find their way back tome.” Existential concerns dominated the thinking of another student: “My per-spective of my life and the world has taken on new meaning. . . . My choiceswould have to be different. Life would have to mean more.” Still others went



even further in describing this new sense of perspective as freeing. “In a sense,my own personal demons have taken a back seat to reality and I find myselfoddly liberated . . . and more willing to extend myself to others.” Indeed manyviewed the September 11th disaster as a “wake-up call” to remind themselvesthat they need to express their love for others more often and more directly.

REACTIVATION OF PREVIOUS TRAUMAS

Although all of the above reactions are compelling and are representative ofthe emotional climate that all of us find ourselves in since September 11th,they are also striking in what they tell us about how people react to trauma, no-ticeably in the way that recent traumas bring up old feelings–and in particularlosses–for the people who are experiencing them. Freud (1914) first ac-quainted us with the idea that it is only when buried memories are brought tothe surface and done away with, called up and dismissed, that the self can bemastered and emancipated from itself; and that it is only by recollecting, re-constructing, and freeing the self from the ghosts of the past that life can gainnew meaning, complexity, and depth, and a healthy future can result. In muchthe same way, as shown in the reactions that follow, it is only by delving intoand understanding our own pasts that we can begin to make sense of the pres-ent trauma we are experiencing, and be of real help to our patients who arestruggling to do the same. What is unifying in these diverse reactions is the factthat the majority of the group members seemed to internalize and interpret theevents of September 11th as a continuation of or a reaction to whatever feel-ings and emotions they were experiencing prior to that time. In other words,the reactions precipitated by the events of September 11th can be seen less asnew reactions to a horrific world event and more as old ways of looking at theworld superimposed on new losses.

One student described her reaction to the events as a feeling that she wasforced to grieve a recent family death again. “Trauma often brings up otherlosses, and I often feel like I am grieving my stepmother’s death all over again.I get distracted and sad and frustrated that history tends to repeat itself,” shenoted. A more dramatic example is the following scene witnessed by anothermember of the class: “One woman abruptly changed her sobs, which originallywere for her brother and his wife, to sobs for herself, when she recounted yearsof sexual abuse at the hands of her father when she was a little girl.”

There are many other poignant examples. “Let me start with pre-September11th because who I am before and despite my reactions to this trauma is crucialto my understanding.” This particular student described her pre-September11th emotional state as being overcritical of herself and depressed, and there-

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fore her reactions to the events as evoking a deep self-hatred. She was notalone; for many students, this crisis not only served to bring them back to oldfeelings of loss, but brought to the surface all the personal issues and feelingsthat made them who they are. For some these were old feelings of insecurity,depression, and lack of control over life; for others they were more positivefeelings of growth and independence. Wherever people found themselves intheir lives prior to September 11th, the events of that day were interpretedthrough the particular lens of the person experiencing them. For some, theevents resulted in a setback to the personal growth and development they hadbeen striving so hard to achieve: “The tragedy of September 11th brought anumber of personal issues to the forefront . . . themes of powerlessness, help-lessness, and lack of control were woven together throughout my life. I desper-ately yearned for peace, security, and safety. I wanted to relax. I wanted to justbe.”

For others the events exacerbated longstanding feelings of anxiety. “Whilemy functioning has remained significantly improved, the impact of theseevents in New York and throughout the world has raised my anxiety level andtriggered the return of my habitual feeling of a lack of control over my envi-ronment,” was one reaction. Others who considered themselves especiallyfearful people prior to the events became more so. One woman described theintense fear she felt following the attacks as an extension of the fears that char-acterized much of her emotional life prior to that time, including a fear of liv-ing on her own, of returning to school after a hiatus, and a general fear offailing in life’s pursuits.

Another woman who described herself as a person who above all “[likes] tohave a sense of control,” acknowledged that the greatest difficulty she was fac-ing as a result of the attacks was a longstanding fear that the “safety and secu-rity” that she took for granted would be “stripped away.” She saw herself as aperson who has always felt detached, not particularly in touch with her emo-tions, and who has “strong feelings but can’t experience them.” She describedher recent anger as directed primarily at newscasters and politicians for in-creasing her anxiety and for “reminding [her] that there is plenty out there to beafraid of” and toward her father for even suggesting that she might want to geta gas mask:

The air was thick and dusty and hurt my lungs and gave me a headache.But it didn’t feel any more real. It looked like a movie set. I didn’t feelconnected or sad. I am sad that they are gone and for their families, but Iam not feeling any deep personal sadness. . . . Lastly, and mostly, I am an-gry at myself. I am not normally an anxious person. I am rational. I don’tjump to conclusions. I am usually good in a crisis. I assess the situation,



see what needs to be done and do it. I like to be in control. Now it seemsthat no one is . . . I am having nightmares and I jump at the sound of sirensand planes. I hate that I feel this way. As I type, I am blinking back tearsagain. As much as I consciously want to cry, to get to that point, my sub-conscious knows better, knows I can’t handle it yet. Maybe I don’t haveto cry but I hope I will.

One student’s rage at the perpetrators of the attacks could be traced back toher own experiences as the child of a Holocaust survivor, giving her a greateracceptance of uncertainty than others and making her more angry than afraid:“Although I have not experienced any form of terror directly, I have neverdoubted its existence or its potential impact on my life and the lives of those Ilove most,” she wrote. Another member of the class attributed many of herfeelings of insecurity, fear, anger at the injustice, and pride in this country toher history as an immigrant to the United States. Yet another student admittedthat throughout her life she had always been more afraid of what “has lurked in[her] imagination,” making her better able to deal with “real crises” than imag-ined ones.

GROUP’S LATER REACTIONS

Commonalities

At the conclusion of the semester, approximately three months from thedate of the disaster, many students revisited certain of their earlier reactions tothe events. That their perspectives were in some respects different at this timecan be attributed both to the period of time that had elapsed since the tragedy,and to the fact that the students were now encouraged to make use of availableresearch and literature relating to trauma, and to consider how certain conceptspertaining to the therapeutic treatment of members of groups applied to themas class members in terms of processing these events. It is particularly note-worthy that whereas three months earlier the students’ reactions varied enor-mously, as shown above, at this later date, their reactions had become moresimilar, at times unified, perhaps in part due to a greater emotional distancefrom the events themselves. How psychological reactions to trauma can varyaccording to the different meanings that individuals and communities attach tothe traumatic event, and the role that memory plays in this process is also cru-cial. The “accuracy of memory is affected by the emotional valence of an expe-rience,” wrote van der Kolk (1996, p. 281). “Meaning is a rich and variedconcept which is not static but results from the interaction of past history, pres-ent context and physiological state. Thus, the meaning of a traumatic event

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changes over time with the individual’s ever changing psychosocial context”(McFarlane & van der Kolk, 1986, p. 20).

As a whole, the class took comfort in the fact that many of their initial reac-tions were similarly documented in the context of other traumatic events in theavailable literature on the subject. These reactions included more negativeones such as the fear of repetition of the stressful events, shame over helpless-ness, rage at the source of the stress, guilt about shame over aggressive im-pulses, fear of identification or merger with the victims, and sadness over loss.More positive reactions included learning that one can handle crisis, becomingmore aware of the importance of family and community, and developing newpriorities, goals, and values (Fullerton et al., 1994). One student seemed partic-ularly relieved to find evidence in the literature of the occurrence of repeatednightmares, a type of nocturnal re-experiencing of traumatic events at nightthrough dreams, whether it is in the form of more symbolic posttraumaticnightmares or a more actual posttraumatic reenactment of the trauma (Schreuder,1996). This documented information helped her normalize her own experiencewith recurrent nightmares following the disaster.

One of the most common themes to emerge from the student reactions atthis later date was the feeling of relief that ensued as a result of the perceiveduniversality of their shared experiences and emotions, and the group cohesionthat developed. One student recognized that the concept of universality in agroup allows members to realize that they are not alone and that there are oth-ers who can understand what they are experiencing because they are experi-encing the same thing, thereby providing members with a sense of support andcomfort and a way to feel less isolated (Toseland & Rivas, 2001). “As a groupwe developed a sense of our individual roles within the class as well as beingone group,” wrote one student. “We taught each other coping and defensemechanisms necessary to get through midterms, finals, and sometimes, just theday.” Citing Yalom (1995, p. 6), one student experienced this feeling as the“disconfirmation of a patient’s feelings of uniqueness. . . [and] a powerfulsource of relief,” resulting in a normalizing effect on group members. Otherscame to see their reactions as acceptable and normal when they heard class-mates share their thoughts and emotions. Another student cited Herman(1992), who addressed the power of group experience in combating the impactof trauma, stating that where “trauma isolates, the group re-creates a sense ofbelonging” (p. 214).

“Although no one was able to come up with a solution for our anxiety re-garding our feelings of helplessness, it was very comforting for me to knowthat others shared my concern,” wrote one student. Another student discussedfeeling a diminished intensity, especially anger, an increase in empathy, and asense of group cohesiveness and belonging. A number of the students attrib-



uted their ability to feel safe in the group to the insight and warmth demon-strated by their professor, whose “quiet strength, patience, warmth, playfulnessand sense of humor” allowed them to feel safe enough to explore their feelingsby giving them the time and the forum to do so. This in turn led to a sense ofsolidarity, a new feeling of confidence, a willingness to listen to others, and adesire to remain in the group. “Empathy, intimacy, trust, and acceptance wereclearly achieved,” wrote one woman.

Another student related that this feeling of commonality, “the realizationthat one is not alone in her experiences” had the strongest impact on her, andhow, instead of feeling “isolated in [her] experiences, unique in [her] prob-lems, and unable to share with others for fear of horror and rejection,” she felt“safe to voice these experiences” and in so doing, learned that she was “notalone” and that her feelings “were common and acceptable to others.” Still oth-ers felt a common bond even in the absence of words. “Those who did not ver-balize their experiences still contributed to the sense of universality throughnods, gestures and smiles of understanding,” wrote one student. “No matterwhat stage we are in there is the comfort we find in the knowledge that we arenot alone in our suffering, confusion, paranoia and anxiety. We have experi-enced this comfort in our class group and for that I am grateful,” she said.

“It made me feel better to know I was not the only one, for many reasons,”said another student.

First, I felt like I was not simply being lazy. Second, I felt like I was notoverreacting. Third, it made me feel like it was ok to have things affectme, even as a social worker. This feeling, of us all being in the same boat,made me feel so much better about my reactions to this trauma in theseand other ways. My fears were universalized and normalized. Peoplewho feel they are alone in having disturbing thoughts or feelings, or feelthey are the only ones to face abuse, neglect, or trauma come to find outthat others have dealt with the same feeling they have. This newfoundknowledge creates an environment that makes it safe to explore these is-sues and process them in a journey toward self-acceptance and psycho-logical health. I felt less guilty and less disgusted with myself.

The students’ research felt like a universal activity to many class members.“Another way my colleagues and I found to universalize our feelings duringthis disaster was through reading the literature on trauma and coming to abetter understanding of its common effects,” wrote one student.

Our experience with this trauma begins as human beings and New York-ers first, and then goes on to experiences as a social worker, therapist,and as a student. Through our class discussions we were able to univer-

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salize our fears of not only the disaster and our safety in New York Cityand America, but of not being good enough social workers to handle thecrisis. We were able to identify with each other over our personal symp-toms and therefore let go of our guilt.

The literature discussed proved that what we were facing was normal and theeffects may last for some time. This also universalized our fears, thoughts, andfeelings, and allowed us to openly discuss our issues throughout the crisis, andas a group, she wrote.

Another student said, “I was surviving in the group and exploring my theo-ries by hearing that others were confused about their roles in life, unmotivatedto do their schoolwork or complete their pursuits, and scared to walk on thestreets at times, because I realized I was not the only crazy person pretending Iwas leading a normal life.” Although at first she had difficulties expressing herown emotions, “I realized I had more to gain from the group experience once Ishared a piece of myself,” said another student. Yet another student wrote thatwhile at first she “felt alone and isolated in that others seemed to be copingbetter,” when she discovered that she was not alone she felt “relief from anxi-ety, more motivated to be part of the group, and not unique in [her] wretched-ness.” Seeing others cry made some more willing to take the risk of exposingthemselves. “I felt very self-conscious because I don’t easily open myself up toa group of strangers like that. I remember thinking to myself, if I can’t do thishere, where can I?” asked another woman.

Another student wrote that it was this feeling of not being alone that got her“through some difficult days. I am and always will be tied to our class, not be-cause it fit into the parameters of successful group work, but because we allwent through something unthinkable together, and I imagine we will all beconnected to this group in a way that we will never be connected to any othergroup again.” Another student wrote, “Slowly, but incredibly, a sense of cohe-siveness, care, compassion and empathy evolved.” “The process has instilledin me feelings of empowerment, independence, and confidence. I take with methe connections with those classmates who assisted me in getting through thissemester, whether they were aware of it or not,” wrote another student.

Some students worried that by delving into the available research on thesubject, they were removing themselves too much from their feelings, and thatthis type of intellectualizing and theorizing about these “unique, intense, andprofound experiences we had as a group this semester left [us] feeling some-what distanced from our experience.” Another student wrote, “Our responsesto the class material became much more intellectualized as we tried to ignorethe elephant in the room.” But perhaps this distance was just illusory, she said,“maybe those feelings aren’t gone, just covered up by daily survival.”



Differences

A few students, however, had very different reactions to the almost group-wideexperience of relief at the shared feelings that developed. A few students evensaid that they experienced a feeling of increased isolation and aloneness. “Onone level, I connected and felt moved by others’ accounts of what happened;on another level I felt angry and sad and completely alone,” wrote one woman.So afraid was she of the “vulnerability of connection,” that she found herself“intellectualizing” the experience. “My own feelings around this tragedy wereof tremendous isolation,” she wrote. “I remember feeling incredibly alone andlonely, needing and wanting connection but at the same time not wanting to bewith anyone.” For her, the sense of commonality and universality so sought af-ter by others was “not the magic that it is portrayed to be.” Nonetheless, she ex-perienced these feelings as valuable. “Feeling this isolation when I am giventhe opportunity of connection has helped me greatly in understanding the ex-perience of group members. I understand how someone can need to feel closeto others and simultaneously need to feel apart from them,” she wrote.

The limits of universality were also seen in the reactions of the followingstudent, who did not experience the same relief at the universality that perme-ated most of the group.

The wildness of my own emotions felt out of place in this group. Perhapstemperamentally I am more a gut person. Perhaps too, September 11stirred anew my own past traumas more than I expected: the horror of thesirens during the war, the roar of planes pregnant with bombs, the run-ning for shelter faster than little feet can go, the dust after a hit, the terrorof not finding my mother, and the ensuing nightmares. No, I will not bequiet, no, I will not be peaceful. But how could I explain all this to a classso polished, so polite, so peaceful, so PC?

This student, whose family fled the Holocaust during World War II, describedherself as searching for another kind of universality, a more spiritual kind, thatof the “great questions,” like the nature of evil and the role of God. “My feebleattempt to talk about God was promptly dropped. On that day I did not feel ei-ther understood or included,” she wrote.

In connection with these feelings, certain class members explored their re-sistance to confronting and discussing their emotions, describing it as“groupwise resistance to the group task” (Cohen, 1997, p. 451). This grapplingtook many forms, including the very way that students defined the concept ofresistance, ranging from the “manifestation of anxiety,” to the integrativevalue of coping and the expression of self-assertion and autonomy (Teitelbaum,1991). One student described the class as “resistant from the first day of class

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due to shock, pain, and the fact that we were virtual strangers to each other.”Another saw her resistance to participating in the group and her inability to getinvolved until late in the semester as characteristic of her behavior in her life asa whole. “No one wanted to participate and I became the silent student I fearedbecoming again. This particular student praised their professor for ”[allowing]us to resist participating, yet “[checking] in regularly with [our] thoughts,emotions and feelings. I was faced with, and struck by the resistance from oth-ers and myself during the classroom session, yet we were unable to steer offtopic,” she wrote.

Another student described the resistance she felt and witnessed in the class-room as intrapsychic resistance (Cohen, 1997), representing almost innate re-sponse to avoid pain.

This type of resistance goes straight for the gut and plays on primaryfears in order to achieve its goal of holding back emotions. In essence,this type of resistance is the one that will take us back to negative memo-ries of past experiences. I think that the shocking events of 9/11 uncov-ered our primal fears of death and existential angst and brought them tothe fore. It is very stressful to have our primal fears become so intenselybased in our present reality. We innately fear change because in a basicway, change implies a death. When this metaphor for change crossedpaths with reality in such a devastating way, it turned everything upsidedown. What could only be imagined became reality, what reality hadbeen, was no more. . . . Our vagueness and inability to stay in the here andnow is what helped us turn away from the difficult feelings of the mo-ment.

Another student saw this resistance take the form not only of silence or“babbling,” but of constricted body language such as sitting “tightly with armsand legs crossed” and lack of eye contact. One student, she reflected, eventhreatened to leave during one of the silences that filled the room. She de-scribed feeling resistant until she “became engulfed and consumed by the sim-ilarities in each of us. I felt the need to indirectly give of myself to others, asthey had done for me,” she explained.

Another student described her experience of the resistance in the room asher unconscious attempt to resist change. “We began our meeting mired infear, dread, and immense sadness, ” she said, and as result of the lack of a feel-ing of safety initially, it was “easier for resistance to sink its teeth into theclass.” According to another student, “Looking back on the dream-like qualityof those first few weeks, I think that perhaps another aspect of not expressingthe emotions in class could be attributed to a resistance to making sense of it alland therefore making it real. It was the type of experience that made you resist



connecting to it, because you wanted to deny that it changed you.” As Herman(1992, p. 1) wrote, this type of “conflict between the will to deny horribleevents, and the will to proclaim them aloud is the central dialectic of psycho-logical trauma.”

IMPLICATIONS FOR CLINICAL PRACTICE

The varied ways that the events of September 11th were personally experi-enced accounted in large measure for the impact these events were felt to haveon one’s clinical practice. For some, the high degree of emotion and preoccu-pation with their own feelings made it almost impossible to reach out to othersin need. Working through their own feelings precluded them from being ableto help others deal with their emotions, whether or not these emotions were di-rectly related to the trauma. “How could I assuage the very fears I was unableto comfort in myself?” one young woman asked of herself. “I felt very inse-cure, and struggled with ethical dilemmas. I wondered whether I was strongenough to completely be there for others while I experienced weaknesses inmyself.” Many shared her sentiments as helplessness and uselessness in theface of their own personal anxiety took precedence over the pain and sufferingof others. “I felt scared and unsafe myself, so when patients talked about feel-ing that way, I had nothing to offer them. They weren’t paranoid, unless I wastoo,” noted one young woman.

For some, these feelings resulted in desensitization toward patients, a lackof empathy, less tolerance of and even anger at patients’ expressions of rageand anxiety. Some saw their patients as self-absorbed, “babbling about non-sensical problems and not caring that a few miles away thousands of people laydead in piles of rubble.” While also viewing themselves as “less patient andmore vulnerable to overidentifying with clients,” many students expressedfeelings of guilt for not being able to provide better care for their patients. Onewoman in particular wondered whether her own desire for retaliation made herunsuitable as a therapist. “Blow them all off the face of the planet ran throughmy head more than once. . . . Should a social worker really be thinking aboutthe things that were going through my head?” she worried.

These emotions notwithstanding, most students viewed going to placementand working in a clinical setting with optimism, determination, and in somecases, even relief. Feeling more, rather than less, connected to patients as a re-sult of the trauma was a welcome response. One student said that while at firstshe did not want to deal with seriously mentally ill patients because they werenot able to look realistically at the events, she later came to realize that theyneeded more help due to their fragile mental state and that she was willing and

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able to give that help. Some students saw going to work as a much needed es-cape, even affording them a welcome sense of perspective. “I find the oneplace where I am most focused and most comfortable in the midst of this is mycancer patient support group. During that time, things are certain, roles are de-fined,” observed one student. “My clinical work has become one of the fewpeaceful things for me,” seconded another.

The desire and the need to communicate with others and to feel involvedand needed were other reactions. Some even saw a certain amount of hope inbeing needed. “I thought that after enduring such stress, confusion, and sad-ness, that I would feel disconnected from my work. At first, I was afraid to re-turn. But when I did, I found that all my unease about the world faded in thepresence of my patients. Despite all the craziness, all the distrust, all the misun-derstanding, all the hatred in the world, there I was, in session, being entrustedwith someone’s story and that felt like a gift of hope,” said one woman. Othersdescribed the desire to help others deal with their feelings and emotions as away to help them find meaning in their own lives. “If we were needed before,now we are acknowledged, and the repercussions of this tragedy and war willcontinue to provide a need for us,” wrote one student. “I feel like I am doingsomething constructive, and still using my emotions, which feels healthy.”

Other students welcomed “being forced to grow up professionally.” Onedescribed a sense of not having time to be a student anymore, leading to a new-found confidence in her clinical work. Others credited the knowledge theygained about trauma work as helping them speed up the learning process andbe more confident as social work students and service providers. “None of ushad any education, training, or experience in this. All we had was our instinctand faith that we would somehow get through this, and get through it together.I spoke up in a way that normally I wouldn’t have, and people listened.” “It’sas though life has a new sense of urgency–both in learning to become a thera-pist and in treating myself by playing more and working less,” wrote anotherstudent.

Some people have been able to find comfort and strength in the fact thatthey are experiencing many of the same emotions as their patients and there-fore feel less alone. One woman realized, “My clients and I are connected in away that would never be otherwise.” Said another, “In a way, helping themprocess helps me process as well.” This feeling of universality leads some toexperience a new sense of openness and inquisitiveness, bringing them towardeven more self-disclosure to patients as a therapist. “First, hearing others dis-cuss their emotional reactions to the frightening events in the world helped meto integrate the fact that I’m not alone. Rather than being unable to act as a con-tainer for my patients’ anxiety, sadness, and fear, experiencing their feelingsprovided me with a sense of universality that was enormously comforting.”



This feeling of shared trauma has also led some students to feel that everyone’semotions and feelings are equally important and deserving of attention.

Perhaps the strongest implication for clinical practice was expressed as theneed for each person to validate and deal with her own feelings first as an indi-vidual, and then as a therapist, demonstrating that only by taking care of our-selves can therapists truly be in a position to help others (Catherall, 1995;Downing & Steed, 1998; Levine, 2001; McCann & Pearlman, 1989; Miller,1998). “A disaster can engender severe crisis in that it threatens self-imagesand identities, life goals and values, and the structure of social systems. It callsfor greatly extended or restricted functioning for which customary coping pat-terns are, for the most part, inadequate. Both individuals and systems becomedisequilibriated and dysfunctional” (Goland quoting Siporin, 1978, p. 126).Because the role of professionals in a disaster is often ambiguous and markedwith feelings of frustration and helplessness, particularly if the workers are in-volved in the trauma, professionals are seen as operating in a dual capacity, asboth fellow victims and professional helpers, sometimes leading to a blurringof their perspective so that they can no longer weigh matters objectively(Goland). Although providing support during times of stress can be rewardingto the support provider, the support provider may become overwhelmed if thedemands are experienced as excessive (McFarlane & van der Kolk, 1996). Thefollowing comments are illustrative of these conflicts and the need for self-care:

It has taken me several weeks to allow myself to accept the fact that I canexperience the loss of thousands, not only with the universally felt devas-tation and sorrow, but in a way that acknowledges and honors the per-sonal loss reaction that it generates in me.

We must remember that to help our clients, we must also help ourselvesbecause it is impossible to isolate our personal and professional lives inlight of the tragedy that we have all experienced.

[I have] the need to work things through in every aspect of my life if Iwish to be an effective social worker in the future.

Somehow along the way, social worker has become another word for,‘Nope, I feel fine–doesn’t affect me at all.’ Speaking about your feelingregarding the tragedy is a given. To know and to feel that it is okay to notbe there all the time is essential. And to recognize and accept that notfeeling ‘strong’ does not mean you are weak is crucial.

Finally, for some, this crisis has validated the choice of social work as a pro-fession, especially for those who gave up lucrative careers to pursue it. The

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pleasure taken in feeling needed is enormous. “My sleep is restless and mynights occupied with wondering. Clearly, my life is different and my thoughtshave changed. Yet what has gotten me through is following my heart. I havechosen a profession that makes a difference. . . . My profession has given mesanity and hope through this terrible time.”

REPERCUSSIONS OF TRAUMATIC STRESS

In allowing for this type of relational process, one must also take into ac-count the danger that the patient can in fact be retraumatized by the therapy,and that the therapist can be vicariously traumatized by the client’s experi-ences. This susceptibility to secondary traumatic stress or vicarious traumatization(Figley, 1995, Herman, 1992; McCann & Pearlman, 1989) has been defined asa change in a helper or therapist’s inner experience that results from empa-thetic connection or identification with a client’s traumatic material (Pearlmanand Saakvitne, 1995), specifically referring to the negative changes that occurover a period of time across a variety of patients and have a cumulative effect(unlike traumatic countertransference which occurs with one client).

Trauma “can actually become contagious,” and “if the therapist shares thepatient’s experiences of helplessness too much, she can become afraid of thepatient and turn away, again retraumatizing the patient” (Berzoff, 1996,p. 423). This problem takes on even greater significance in the context of thepresent scenario where both the patients and the therapists have experienced,and on some level are still experiencing, the same traumatic events. Indeed, inan effort to avoid feeling retraumatized some students reported that they wereat times “not present” in sessions and had become somewhat “desensitized.”

Wall (2001) also normalizes this type of therapists reaction by stating thatfollowing a traumatic event “clinicians are understandably psychically pre-oc-cupied with their own realities” and find it “more difficult or impossible . . . tohave the emotional energy available for clients” (p. 142). This kind of disen-gagement can result in some student therapists feeling guilty that they are notproviding their patients with the quality of care they deserve. Wall understandsthis reaction as the therapists’ experience of guilt at abandoning their clients,therapists having their own needs, or therapists not being omnipotent. Accord-ing to Hafeez, Hertz, Kefer, and Motta (1999), symptoms of secondary traumacan include unwanted recollections of the traumatic event, sudden re-experi-encing of the event, detachment, difficulty concentrating, and sleep distur-bances. Miller (1998) believes that effective trauma therapists need to haveinsight into their own feelings, the capacity for empathy, and the ability to dif-



ferentiate between the needs of the self and of the patient, and the skill to con-ceptualize the patient’s dynamics in the present and the past.

CONCLUSION

This paper has attempted to demonstrate, through the personal essays andgroup discussions by social work students, the crucial interplay between theirpersonal reactions to trauma and their ability to treat patients who are experi-encing many of the same reactions to the events as they are. In order for thera-pists to be able to help others with their feelings relating to trauma, it is crucialthat they examine and work through their own personal feelings about theevents as they interpret and assimilate these events within their own particularpsychological profiles, and in particular how therapists’ own personal trau-mas, as well as their beliefs about patients could interact with their patients’trauma and their regard for such patients (Liebkind & Eranen, 2001).

Mourning is a necessary but painful process for patients and therapistsalike. In many respects the trauma experienced in the aftermath of September11th was felt primarily as a loss. The process of therapy, much like the act ofmourning, allows both therapist and patient to re-create other unconsciouslosses, bring them to the surface, and move on. What is crucial in understand-ing the unique situation inspired by the events of September 11th is that boththerapist and patient are involved in the process of mourning at the same timeand over the same loss, with the therapist having the added complication(which some consider a gift) of being the caregiver and the container in thisprocess as well. In considering loss, one must also include unresolved “ambig-uous” losses that can be incomplete or uncertain (Boss, 1999). Those personspresumed to be dead as a result of the attacks but whose bodies have not beenrecovered can, in this way, entail a feeling of ambiguous loss. A therapist’spersonal experience of loss is likely to have an impact on how patients dealwith loss (Warshaw, 1996), and how the ongoing work towards the resolutionof related issues will affect the therapist’s evolving beliefs about the treatmentprocess.

Herman (1992) wrote that in order for group therapy to afford the partici-pants a feeling of commonality and universality, and thereby restore to them afeeling of connection to others, a feeling that they are not alone, a renewedsense of humanity in general, and a reclaimed sense of self, survivors must beprepared to give up a feeling of specialness and see themselves as part of theordinary fabric of the human condition, a “drop of rain in the sea” (Hermanquoting Richard Rhodes, p. 235), small and insignificant. This is particularlytrue in cases of traumatic events that “destroy the sustaining bonds between in-dividual and community” (Herman, p. 214). However, as borne out by the reac-

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tions above, it is equally if not more important for both participant andtherapist to see themselves as large and hugely significant, and to embrace thatsame feeling of specialness that will give them the strength and the courage tobattle whatever internal demons rage within them and overcome whatevertrauma an unpredictable world may inflict. In this same way, as most if not allof the sentiments presented suggest, in order for us as therapists to be success-ful in caring for others, we must face and continue to evaluate our own feelingsand keep them in mind in the context of helping others, especially in the con-text of the events that transpired on that fateful day in September.

There are no objective guidelines in this case for establishing where thetherapist as individual ends and the individual as therapist begins. As Yalom(1985, p. 225) wisely writes:

In the therapy group, freedom becomes possible and constructive onlywhen it is coupled with responsibility. None of us is free from impulsesor feelings that, if expressed, could be destructive to another. I suggestthat we encourage patients and therapists to speak freely, to shed all in-ternal censors and filters save one, the filter of responsibility . . . the ther-apist has a particular type of responsibility, responsibility to patients andto the task of therapy.

The best we can hope for is that each of us takes this responsibility seriously.

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