Therapy After Terror: 9/11, Psychotherapists, and Mental Health.
Trent, September K. ; Sutton, Geoffrey W.
THERAPY AFTER TERROR: 9/11, PSYCHOTHERAPISTS, AND MENTAL HEALTH.
Karen M. Seeley. New York: Cambridge University Press. Hardcover. 242
pp. $35.00. ISBN: 978-0-521-88422-8.
"Everybody's trauma was so raw. It didn't matter who
you were talking to--relief worker, direct victim, other therapists--you
were all the same body in some ways" (p. 152). Seeley peppers her
analysis of the effects of 9/11 on psychotherapists and the field of
mental health with excerpts from pungent and thoughtful interviews. We
glimpse the chaos through the eyes of psychotherapists who lived the
trauma in their personal and professional lives. On the morning of
September 11, 2001, New York therapists are running to the Red Cross
shelters to donate their time, psychologists are treating patients who
are eyewitnesses to the worst enemy attack on the American homeland, and
counselors, themselves victims who lost everything, are trying to
counsel others through trauma-colored lenses. Seeley examines the
diagnosis of Post Traumatic Stress Disorder in light of the severe
impact of the terrorist attacks and the difficulties mental health
professionals had when attempting to formulate a diagnosis. The author,
Karen M. Seeley, MSW, Ph.D., is a clinical social worker and cultural
psychologist in the Anthropology Department at Columbia University. In
addition to her academic qualifications, she provides a highly readable
and thoughtful analysis of psychotherapy in the context of terror.
In the first and second chapters, the events of 9/11 are retold in
the context of therapists' views of the event and their attempts to
donate their skills. Project Liberty, a government funded mental health
project, was formed immediately following 9/11 to help its victims deal
with their unsteady mental health. Seeley uses personal recounts by
psychotherapists as they tried to volunteer their services for Project
Liberty and the Red Cross. Many psychotherapists experienced confusion,
which they attributed to problems of organization and education about
handling a mental health crisis. Most of the professionals did not feel
helpful because they were sent to places where no victims arrived. Only
later did they learn that no victims arrived because so few survived the
twin towers attack.
As readers, we gain insights from Seeley and the psychotherapists
that are notably different perspectives on the effects of the terrorist
attacks. Because the American mass media focused on the visual assault
and the horrific destruction, an in-depth exploration of the
psychological sequellae has been missing. Seeley illustrates how the
emotional aftermath silently but powerfully impacted a wide swath of
people in New York City. In particular, the psychotherapists'
stories are heart wrenching. Their narratives take the reader to ground
zero, facilities where families are struggling to find lost loved ones,
and the private offices of psychologists. Through Seeley's
reconstructed timeline of the events and the ineffective efforts to cope
with the trauma by some of New York's most experienced therapists,
chapters one and two capture the reader's desire to learn the
lessons from these untold stories of 9/11.
A few days after 9/11, the Red Cross and Project Liberty identified
the problems and places where psychotherapists were needed. Chapters
three and four explore a range of psychotherapists' experiences in
different facilities. Both the Red Cross and Project Liberty sent
psychotherapists to ground zero to talk with fire fighters, police, and
construction workers who were searching for survivors. other
professionals were sent to Family Assistance Centers or service Centers
that were set up by the government to help families find and identify
lost loved ones and to obtain monetary support from the government. All
of the psychotherapists spoke about the extreme difficulty they
experienced in trying to help so many victims and their families. The
workers at ground zero did not want to talk about anything; they wanted
to keep working because they might find one of their fallen colleagues.
For the families of those who were in the twin towers, it was difficult
to accept a loss that included no remnants of their dead family members.
A poignant example of emotional pain is one psychotherapist's
report of a family receiving a container representing the ashes of their
loved one from one of Rudy Giuliani's aides. Seeley offers great
insight into the emotional vulnerability of many different kinds of
victims--both clients and psychotherapists. As clinicians we appreciate
the analysis but, as ordinary readers, we are captivated by the stories
and yearn to know what happened to these people.
Chapters five and six discuss the toll that helping trauma
survivors takes on psychotherapists and the problematic diagnosis of
Posttraumatic Stress Disorder. All of the psychotherapists experienced
the same emotions that their clients experienced. Many of the
psychotherapists lived through the same traumatic events as did their
clients. Understandably, psychotherapists found it difficult to hide
their own emotions and experiences during psychotherapy so that their
clients could fully disclose their feelings and focus on their recovery.
How appropriate is it for psychotherapists to treat clients while
struggling to manage the same symptoms? Many New York therapists did
just that. They felt that they had to help the victims; the
victims' mental health was more important than their own. with
every new client and every recounting, the psychotherapists were
retraumatized. Should psychotherapists endanger themselves under extreme
circumstances?
Related to the problem of psychotherapists' perspective on the
trauma, is the difficulty they experienced in diagnosing their clients.
Many diagnosed their clients with Posttraumatic Stress Disorder (PTSD)
without considering the time the client had experienced the symptoms or
the related diagnosis of Acute Stress Disorder. Many psychotherapists
felt that the Diagnostic and Statistical Manual (DSM) was not useful in
the diagnosis of victims from 9/11 because there was no appropriate
diagnosis. Complicating the psychotherapists' dilemma were signs
listing PTSD symptoms posted throughout New York City. Although PTSD
came closest to the expressed symptoms, other nuances could not be
accounted for such as the variations in intensity of responses
experienced by those walking among human debris versus those
experiencing and re-experiencing the visual violence on television and
realizing their husband or wife was in that conflagration. She closes
chapter six with a thoughtful discussion of emotional contagion as so
many trauma victims in close proximity shared their stories and
symptoms. Disturbingly, some of these were also psychotherapists, who
may have increased rather than alleviated the trauma.
In the last chapters, Seeley summarizes what psychotherapists
learned about trauma and how to treat it. Numerous classes and programs
are not educating the psychological community because many of the
psychotherapists felt incompetent. Many of the psychotherapists
questioned the relevance of traditional psychotherapy. They felt that
the therapy sessions and all the theories of psychology that they had
been taught were not working. The question of theory has stimulated
research about the psychological impact of 9/11 and effective treatments
for victims of extreme trauma. Seeley identifies spirituality as one
dimension that can be helpful to those experiencing trauma. Many
psychotherapists found it exceedingly difficult to work with clients who
had no spirituality. Psychotherapists will find that these last chapters
are very informative because Seeley identifies specific problems and
difficulties experienced by victims of terrorist attacks.
We believe readers will benefit from Seeley's informed
psychological perspective on the terrorist attacks of 9/11. Although
Seeley briefly discusses spirituality, readers of JPC will find that God
is mostly absent from the analysis. Given her post-trauma perspective,
we can excuse Seeley from a theological discussion of the attack. Yet,
we wonder about the spirituality of the psychotherapists and their
clients. were people of faith any more compassionate than others? Did
any feel empowered by their faith to serve others? Did any have a
healthy spirituality that, despite feeling wounded at the time, served
as a catalyst to their recovery?
Reviewed by September K. Trent and Geoffrey W. Sutton (Evangel
University/Springfield, MO).